Klein R C
Cardiology Division, University of Utah Medical Center, Salt Lake City 84132.
Eur Heart J. 1993 Nov;14 Suppl H:78-84. doi: 10.1093/eurheartj/14.suppl_h.78.
The ESVEM Trial was a randomized prospective study to compare the predictive accuracy of electrophysiologic testing (EPS) to ambulatory electrocardiographic monitoring (Holter monitoring--HM) for long-term drug therapy of sustained ventricular tachyarrhythmias. 486 patients with documented ventricular tachycardia or resuscitated sudden death were randomized to EPS (n = 242) or HM (n = 244) and underwent serial drug testing with up to six antiarrhythmics; in the EPS limb a drug efficacy prediction was achieved in 108 patients (45%), compared to 188 (77%) in the HM limb (P < 0.001). Efficacy predictions were most frequent with sotalol therapy. During long-term follow-up of the 296 patients discharged on a drug predicted to be effective, there were 151 recurrences of an arrhythmic event; there were no differences in actuarial rates of arrhythmia recurrence between EPS and HM. With multivariate testing of 14 variables, only sotalol therapy and absence of prior antiarrhythmic therapy were associated with a significant reduction in risk of arrhythmia recurrence.
ESVEM试验是一项随机前瞻性研究，旨在比较电生理检查（EPS）与动态心电图监测（Holter监测-HM）对持续性室性心律失常长期药物治疗的预测准确性。486例有室性心动过速记录或复苏成功的心脏骤停患者被随机分为EPS组（n = 242）或HM组（n = 244），并接受了多达六种抗心律失常药物的系列药物测试；在EPS组中，108例患者（45%）实现了药物疗效预测。相比之下，HM组有188例（77%）实现了药物疗效预测（P < 0.001）。索他洛尔治疗时疗效预测最为常见。在对296例接受预测有效的药物出院的患者进行长期随访期间，有151例心律失常事件复发；EPS组和HM组心律失常复发的精算率没有差异。对14个变量进行多因素测试时，只有索他洛尔治疗和既往未接受抗心律失常治疗与心律失常复发风险显著降低相关。
