Kulakowski P, Bashir Y, Heald S, Paul V, Anderson M H, Gibson S, Malik M, Camm A J
Department of Cardiological Sciences, St. George's Hospital Medical School, London, England, United Kingdom.
J Am Coll Cardiol. 1993 May;21(6):1428-39. doi: 10.1016/0735-1097(93)90320-z.
The aim of this study was to assess the ability of the signal-averaged electrocardiogram (ECG) to predict the efficacy of procainamide.
The main role of the signal-averaged ECG has been the identification of postinfarction patients at risk of sudden death. Prediction of the efficacy of antiarrhythmic drugs represents another potential clinical application of this technique.
The study examined the effects of procainamide on the time domain and spectral temporal analysis of the signal-averaged ECG in relation to the results of programmed ventricular stimulation studies in 31 patients with inducible sustained monomorphic ventricular tachycardia.
Procainamide significantly prolonged the total and the initial QRS complex and low amplitude signal durations (mean +/- SD 135 +/- 30 vs. 161 +/- 46 ms, p < 0.0001; 87 +/- 16 vs. 98 +/- 20 ms, p < 0.0001, and 48 +/- 23 vs. 63 +/- 36 ms, p < 0.001, respectively) whereas the root-mean-square voltage of the total QRS complex and of the last 40 ms of the QRS complex was significantly reduced (mean +/- SD 112 +/- 36 vs. 87 +/- 36 microV, p < 0.0001; 21 +/- 19 vs. 13 +/- 12 microV, p < 0.002, respectively). The results of spectral temporal mapping of the signal-averaged ECG were similar before and after procainamide administration. Procainamide prevented the inducibility of sustained ventricular tachycardia or prolonged the cycle length of ventricular tachycardia by > or = 100 ms in 16 patients (52%) (responders). The fractional prolongation of the total QRS duration was significantly greater in responders (26 +/- 15%) than in nonresponders (10 +/- 10%) (p < 0.002) and, when this prolongation was > or = 15%, identified responders with a sensitivity of 94%, a specificity of 87% and an overall predictive accuracy of 90%.
The effects of procainamide on inducibility of ventricular tachycardia during programmed ventricular stimulation can be predicted by the degree of drug-induced prolongation of the signal-averaged QRS complex.
本研究旨在评估信号平均心电图（ECG）预测普鲁卡因胺疗效的能力。
信号平均心电图的主要作用是识别心肌梗死后有猝死风险的患者。预测抗心律失常药物的疗效是该技术的另一个潜在临床应用。
本研究检测了31例可诱发持续性单形性室性心动过速患者中，普鲁卡因胺对信号平均心电图时域和频谱时域分析的影响，并与程控心室刺激研究结果进行对比。
普鲁卡因胺显著延长了总的和初始的QRS波群以及低振幅信号持续时间（均值±标准差分别为135±30 vs. 161±46 ms，p<0.0001；87±16 vs. 98±20 ms，p<0.0001，以及48±23 vs. 63±36 ms，p<0.001），而总的QRS波群以及QRS波群最后40 ms的均方根电压显著降低（均值±标准差分别为112±36 vs. 87±36 μV，p<0.0001；21±19 vs. 13±12 μV，p<0.002）。普鲁卡因胺给药前后信号平均心电图的频谱时域图结果相似。普鲁卡因胺使16例患者（52%）（反应者）的持续性室性心动过速不能被诱发，或使室性心动过速的周期长度延长≥100 ms。反应者总的QRS持续时间的延长分数显著高于无反应者（26±15%比10±10%）（p<0.002），当这种延长≥15%时，识别反应者的敏感度为94%，特异度为87%，总体预测准确率为90%。
程控心室刺激期间，普鲁卡因胺对室性心动过速诱发能力的影响可通过药物诱导的信号平均QRS波群延长程度来预测。
