Tsuchiya M, Kasanuki H, Ohnishi S, Hosoda S
Department of Cardiology, Heart Institute of Japan, Tokyo Women's Medical College.
J Cardiol. 1996 Nov;28(5):267-76.
The usefulness of electrophysiologic study and Holter monitoring for predicting the long-term efficacy of amiodarone was investigated in 31 patients with sustained ventricular tachycardia (VT) and organic heart disease. Patients underwent both electrophysiologic study and Holter monitoring before and during oral administration of amiodarone. These patients were followed up and the difference in the prognosis according to the results of these two tests was examined. During a follow-up period of 887 +/- 678 days, sustained VT recurred in 13 patients and sudden cardiac death in 3. Sustained VT recurred in only one of 11 patients in whom amiodarone was determined effective by electrophysiologic study whereas recurrent VT and/or sudden death occurred in 15 of 20 patients in whom amiodarone was determined ineffective (p < 0.01). Eight of 18 patients in whom amiodarone was determined effective by Holter monitoring, and 8 of 13 in whom it was determined ineffective, suffered recurrent VT and/or sudden cardiac death. Amiodarone was judged effective in 7 patients by both tests (group I) and in 15 by either electrophysiologic study or Holter monitoring (group II). In the remaining nine patients, amiodarone was ineffective by both tests (group III). Recurrent VT or sudden death occurred in none of the patients in group I (0%), in nine group II (60%) and seven in group III (78%). The prognoses of the three groups were significantly different: group I vs II; p < 0.05, group II vs III: p < 0.05, and group I vs III; p < 0.005. The combination of the two drug tests, electrophysiologic study and Holter monitoring, is a useful method for the prediction of the long-term efficacy of amiodarone in patients with sustained VT and underlying heart disease. Patients in whom amiodarone was determined ineffective in both tests, are at high risk for VT recurrence and sudden death, and interventional therapy is recommended.
在31例持续性室性心动过速（VT）且患有器质性心脏病的患者中，研究了电生理检查和动态心电图监测对预测胺碘酮长期疗效的作用。患者在口服胺碘酮之前和期间均接受了电生理检查和动态心电图监测。对这些患者进行随访，并根据这两项检查的结果检查预后差异。在887±678天的随访期内，13例患者出现持续性室性心动过速复发，3例发生心源性猝死。在11例经电生理检查确定胺碘酮有效的患者中，只有1例出现持续性室性心动过速复发，而在20例经电生理检查确定胺碘酮无效的患者中，有15例出现室性心动过速复发和/或猝死（p<0.01）。在18例经动态心电图监测确定胺碘酮有效的患者中，有8例出现室性心动过速复发和/或心源性猝死，在13例经动态心电图监测确定胺碘酮无效的患者中，有8例出现室性心动过速复发和/或心源性猝死。两项检查均判定7例患者胺碘酮有效（I组），电生理检查或动态心电图监测判定15例患者胺碘酮有效（II组）。其余9例患者两项检查均显示胺碘酮无效（III组）。I组患者均未出现室性心动过速复发或猝死（0%），II组9例（60%），III组7例（78%）。三组的预后有显著差异：I组与II组比较，p<0.05；II组与III组比较，p<0.05；I组与III组比较，p<0.005。电生理检查和动态心电图监测这两种药物检查相结合，是预测胺碘酮对持续性室性心动过速合并基础心脏病患者长期疗效的有用方法。两项检查均判定胺碘酮无效的患者，室性心动过速复发和猝死风险高，建议进行介入治疗。
