Chen X, Shenasa M, Borggrefe M, Block M, Hindricks G, Martinez-Rubio A, Haverkamp W, Willems S, Böcker D, Mäkijärvi M
Hospital of the Westfälische Wilhems-University of Münster, Department of Cardiology/Angiology, Germany.
Eur Heart J. 1994 Jan;15(1):76-82. doi: 10.1093/oxfordjournals.eurheartj.a060383.
The role of programmed ventricular stimulation (PVS) in patients at high risk of sudden death related to idiopathic dilated cardiomyopathy (DCM) is still controversial. The possible reason is that most study series have been too small or that only a few patients had documented sustained ventricular tachyarrhythmias. This study therefore, looked at PVS performed in 102 patients with DCM and documented sustained ventricular tachycardia (VT; n = 63) or ventricular fibrillation (VF; n = 39). Sustained VT was induced in 27 of 63 patients (43%) with documented sustained VT and in 14 of 39 patients (36%) with documented VF (ns). VF was induced in nine patients (14%) with a history of sustained VT and in seven (18%) with a history of VF (ns). At a mean follow-up of 32 +/- 15 months, sudden death occurred in 14 (14%) patients, a rate similar in both patients with documented VT and VF (ns). Incidence of sudden death at 36 months was 6% in patients with inducible sustained VT/VF compared to 29% in patients without inducible VT/VF (P < 0.05). A favourable drug regimen (response to drug and no intolerable side effects) was obtained by serial drug testing in 25 of all 102 patients (25%). A cardioverter defibrillator (ICD) was implanted in 32 patients, in 63% of whom discharges were observed during 18 +/- 11 months of follow-up; only one patient (3%) died suddenly. Thus, in patients with DCM, there was no relationship between documented and inducible ventricular tachyarrhythmias, and initiation of sustained VT or VF had little prognostic value for the prediction of subsequent sudden death. Wherever antiarrhythmic drug therapy was of limited value, implantation of an ICD may improve the prognosis of these high risk patients.
程序性心室刺激（PVS）在与特发性扩张型心肌病（DCM）相关的猝死高危患者中的作用仍存在争议。可能的原因是大多数研究系列规模太小，或者只有少数患者记录到持续性室性心律失常。因此，本研究观察了102例DCM患者接受的PVS，并记录了持续性室性心动过速（VT；n = 63）或心室颤动（VF；n = 39）情况。在63例记录有持续性VT的患者中，27例（43%）诱发出持续性VT；在39例记录有VF的患者中，14例（36%）诱发出VF（无显著性差异）。有持续性VT病史的9例患者（14%）诱发出VF，有VF病史的7例患者（18%）诱发出VF（无显著性差异）。平均随访32±15个月时，14例（14%）患者发生猝死，记录有VT和VF的患者猝死率相似（无显著性差异）。可诱发出持续性VT/VF的患者36个月时的猝死发生率为6%，而不可诱发出VT/VF的患者为29%（P<0.05）。通过对全部102例患者中的25例（25%）进行系列药物测试，获得了良好的药物治疗方案（对药物有反应且无不可耐受的副作用）。32例患者植入了心脏复律除颤器（ICD），其中63%的患者在18±11个月的随访期间观察到有放电情况；仅1例患者（3%）猝死。因此，在DCM患者中，记录到的和可诱发出的室性心律失常之间没有关联，持续性VT或VF的起始对预测随后的猝死几乎没有预后价值。在抗心律失常药物治疗价值有限的情况下，植入ICD可能会改善这些高危患者的预后。
