Jug M, Batinić Z, Goldner V, Delimar N
Klinika za bolesti srca i krvnih zila Medicinskog fakulteta i klinickog bolnickog centra u Zagrebu.
Lijec Vjesn. 1995 Mar-Apr;117(3-4):68-72.
We studied 76 patients with first recent myocardial infarction being not older than 12 hours. The patients included 58 men and 18 women. Their mean age was 62 years. We recorded continuously during the first three days following infarction the heart rate, all forms of ventricular premature beats, ventricular tachycardia, ventricular fibrillation, clinical status and activity of creatinine-phosphokinase and its isoenzyme MB. The results showed that ventricular premature beats (coupled and multiform) as well as ventricular tachycardia were more frequent in the first day of illness, while ventricular premature beats (except bigeminy, for which there is no explanation) were infrequent in the second and the third day after development of an infarct. The incidence of ventricular tachycardia during the follow-up period did not differ significantly. Ventricular fibrillation developed in 7 patients (9.2%). A comparison of the relation between ventricular premature beats and malignant ventricular tachycardia, i.e. ventricular tachycardia and ventricular fibrillation, revealed that the patients with more frequent ventricular tachycardia usually had frequent ventricular premature beats, particularly more often bigeminy, trigeminy, polymorphous ventricular premature and coupled ventricular premature beats, but not ventricular premature beats with R-on-T phenomenon. Ventricular tachycardia, however, was also found in patients with an evidence of more rare ventricular premature beats. This suggests that the occurrence of aforementioned forms of ventricular premature beats denotes only a somewhat greater probability that ventricular tachycardia will occur. The fact that there is a lack of correlation between ventricular tachycardia and R-on-T phenomenon indicates that this probability is not so significant. In conclusion, the authors believe that the patients with recent myocardial infarction and ventricular premature beats should be adequately followed up, and that prophylactic antiarrhythmic therapy is not required in most cases, as it was previously widely accepted concept. It should be administered only when ventricular tachycardia develops. Patients with ventricular fibrillation had more frequent ventricular premature beats, although ventricular premature beats in these patients were not statistically more frequent from those found in the patients in whom ventricular fibrillation was not verified. The presence or absence of ventricular tachycardia and ventricular fibrillation, respectively, had no influence on the other followed up parameters.
我们研究了76例首次发生近期心肌梗死且发病时间不超过12小时的患者。患者包括58名男性和18名女性。他们的平均年龄为62岁。在梗死发生后的头三天，我们持续记录心率、各种形式的室性早搏、室性心动过速、心室颤动、临床状况以及肌酸磷酸激酶及其同工酶MB的活性。结果显示，室性早搏（成对和多形性）以及室性心动过速在发病第一天更为频繁，而在梗死发生后的第二天和第三天，室性早搏（除了无法解释的二联律）则不常见。随访期间室性心动过速的发生率无显著差异。7例患者（9.2%）发生了心室颤动。对室性早搏与恶性室性心动过速（即室性心动过速和心室颤动）之间的关系进行比较发现，室性心动过速较频繁的患者通常室性早搏也较频繁，尤其是更常出现二联律、三联律、多形性室性早搏和成对室性早搏，但不是R波落在T波上现象的室性早搏。然而，在室性早搏较少的患者中也发现了室性心动过速。这表明上述形式的室性早搏的出现仅表示室性心动过速发生的可能性稍大一些。室性心动过速与R波落在T波上现象之间缺乏相关性这一事实表明这种可能性并不那么显著。总之，作者认为，近期心肌梗死合并室性早搏的患者应进行充分随访，并且如之前广泛接受的观念那样，大多数情况下不需要预防性抗心律失常治疗。只有在发生室性心动过速时才应给予治疗。发生心室颤动的患者室性早搏更频繁，尽管这些患者的室性早搏与未证实发生心室颤动的患者相比在统计学上并无更频繁。室性心动过速和心室颤动的有无分别对其他随访参数没有影响。
