Martinez-Rubio A, Shenasa M, Borggrefe M, Chen X, Benning F, Breithardt G
Hospital of the University of Münster, Department of Cardiology and Angiology, Germany.
J Am Coll Cardiol. 1993 Jun;21(7):1624-31. doi: 10.1016/0735-1097(93)90378-e.
The aim of this study was to analyze the relations between the presence of ventricular conduction delay and the necessary coupling intervals for the induction of sustained ventricular tachyarrhythmias.
The electrophysiologic and signal-averaged electrocardiographic (ECG) data from 83 patients with previous myocardial infarction and inducible sustained monomorphic ventricular tachycardia (n = 71) and ventricular fibrillation (n = 12) were analyzed.
The sum of the coupling intervals needed for inducing ventricular tachycardia and ventricular fibrillation was 485 +/- 59 ms and 387 +/- 36 ms, respectively (p < 0.001). The mean difference between the effective refractory period and the second coupling interval for the induction of ventricular tachycardia and ventricular fibrillation was -3 +/- 40 ms and 24 +/- 29 ms, respectively (p < 0.02). QRS duration and duration of terminal low amplitude signals of the QRS complex (p < 0.004) were longer in patients with inducible ventricular tachycardia than in patients with inducible ventricular fibrillation. The root mean square of the voltage during the last 40 ms of QRS complex was lower in patients with inducible ventricular tachycardia than in patients with inducible ventricular fibrillation (p < 0.007). Patients with inducible ventricular tachycardia presented with a greater prevalence of ventricular late potentials than that of patients with inducible ventricular fibrillation (p < 0.007). For arrhythmia induction, significantly shorter coupling intervals were necessary in patients without than in patients with ventricular late potentials. A positive correlation was found between the cycle length of the induced ventricular tachycardia and the filtered QRS duration as well as with the sum of the coupling intervals.
Induction of ventricular fibrillation requires shorter coupling intervals than does induction of ventricular tachycardia. The presence of ventricular conduction delay seems to be a marker of facilitated induction of sustained monomorphic ventricular tachycardia rather than of ventricular fibrillation. The coupling intervals required to induce ventricular tachycardia or fibrillation are longer in patients with than in those without an abnormal signal-averaged ECG.
本研究旨在分析心室传导延迟的存在与诱发持续性室性快速心律失常所需的联律间期之间的关系。
分析了83例既往有心肌梗死且可诱发持续性单形性室性心动过速（n = 71）和心室颤动（n = 12）患者的电生理和信号平均心电图（ECG）数据。
诱发室性心动过速和心室颤动所需的联律间期总和分别为485±59 ms和387±36 ms（p < 0.001）。诱发室性心动过速和心室颤动时，有效不应期与第二个联律间期的平均差值分别为 -3±40 ms和24±29 ms（p < 0.02）。可诱发室性心动过速的患者的QRS时限和QRS波群终末低振幅信号的时限（p < 0.004）比可诱发心室颤动的患者更长。可诱发室性心动过速的患者QRS波群最后40 ms期间的电压均方根低于可诱发心室颤动的患者（p < 0.007）。可诱发室性心动过速的患者心室晚电位的患病率高于可诱发心室颤动的患者（p < 0.007）。对于心律失常的诱发，无心室晚电位的患者比有心室晚电位的患者需要明显更短的联律间期。在诱发的室性心动过速的周期长度与滤波后的QRS时限以及联律间期总和之间发现正相关。
诱发心室颤动比诱发室性心动过速需要更短的联律间期。心室传导延迟的存在似乎是持续性单形性室性心动过速易诱发的标志，而非心室颤动的标志。诱发室性心动过速或颤动所需的联律间期在有异常信号平均心电图的患者中比在无异常信号平均心电图的患者中更长。
