Mason J W
Cardiology Division, University of Utah School of Medicine, Salt Lake City 84132.
N Engl J Med. 1993 Aug 12;329(7):445-51. doi: 10.1056/NEJM199308123290701.
Invasive electrophysiologic study and noninvasive Holter monitoring (in conjunction with exercise testing) have both been used to evaluate the efficacy of antiarrhythmic drugs in patients with sustained ventricular tachycardia and in survivors of cardiac arrest. We directly compared these two approaches to the prediction of drug efficacy.
A total of 486 patients who had documented ventricular tachyarrhythmias that were inducible during electrophysiologic study and 10 or more premature ventricular complexes per hour during Holter monitoring were randomly assigned to undergo serial testing of antiarrhythmic-drug efficacy by electrophysiologic study or Holter monitoring. The patients received up to six drugs in random order until one was predicted to be effective either in suppressing inducible arrhythmia (in the electrophysiologic-study group) or in suppressing premature ventricular complexes (in the Holter-monitoring group). The patients were then followed for recurrences of arrhythmia or death.
In the electrophysiologic-study group, 108 of 242 patients (45 percent) received a prediction of efficacy, as compared with 188 of 244 patients (77 percent) in the Holter-monitoring group (P < 0.001). Over a six-year follow-up period, there were 150 recurrences of arrhythmia and 46 deaths among the 296 patients receiving drugs predicted to be effective. Thirty-four of the deaths were from arrhythmic causes, and eight were from cardiac causes. There was no significant difference between the two study groups in the actuarial probabilities of these events. The risk of a recurrence of arrhythmia was significantly lower in patients who received sotalol than in those who received other antiarrhythmic drugs, and the risk was lower in those who had not previously failed to respond to antiarrhythmic drugs than in those who had.
Although Holter monitoring led to predictions of antiarrhythmic-drug efficacy more often than did electrophysiologic study in patients with sustained ventricular tachyarrhythmias, there was no significant difference in the success of drug therapy as selected by the two methods.
侵入性电生理研究和非侵入性动态心电图监测（结合运动试验）均已用于评估抗心律失常药物对持续性室性心动过速患者及心脏骤停幸存者的疗效。我们直接比较了这两种预测药物疗效的方法。
共有486例患者，其在电生理研究中可诱发出室性心律失常，且在动态心电图监测中每小时有10次或更多室性早搏，将这些患者随机分配，通过电生理研究或动态心电图监测对其抗心律失常药物疗效进行系列检测。患者按随机顺序接受多达六种药物治疗，直到预测其中一种药物可有效抑制诱发性心律失常（电生理研究组）或抑制室性早搏（动态心电图监测组）。然后对患者进行随访，观察心律失常复发或死亡情况。
在电生理研究组，242例患者中有108例（45%）被预测药物有效，而在动态心电图监测组，244例患者中有188例（77%）被预测药物有效（P<0.001）。在为期六年的随访期内，在接受预测为有效的药物治疗的296例患者中，有150例心律失常复发，46例死亡。其中34例死亡由心律失常导致，8例由心脏原因导致。两个研究组在这些事件的精算概率上无显著差异。接受索他洛尔治疗的患者心律失常复发风险显著低于接受其他抗心律失常药物治疗的患者，且既往对抗心律失常药物无治疗反应者的复发风险高于有治疗反应者。
尽管在持续性室性心律失常患者中，动态心电图监测比电生理研究更常能预测抗心律失常药物的疗效，但两种方法所选择的药物治疗成功率并无显著差异。
