Meyerfeldt U, Schirdewan A, Wiedemann M, Schütt H, Zimmerman F, Luft F C, Dietz R
Franz Volhard Clinic, Max Delbrück Center for Molecular Medicine, Virchow Klinikum, Humboldt University of Berlin, Germany.
Eur Heart J. 1997 Dec;18(12):1956-65. doi: 10.1093/oxfordjournals.eurheartj.a015206.
The purpose of our study was to investigate the electrical trigger modes of monomorphic ventricular tachycardia, by analysing stored intracardiac electrograms, and to identify haemodynamic or electrocardiographic predictors in patients with cardioverter-defribrillators.
We recorded 286 episodes of monomorphic ventricular tachycardia in 38 patients with at least three events. The electrical triggers were characterized by the morphology number, complexity, and coupling interval of premature depolarizations preceding the ventricular tachycardia. We also evaluated clinical and electrocardiographic data.
We found two basic electrical trigger modes. Two hundred and sixteen events (75%) were observed to have no RR-interval variations before onset, while 70 episodes (25%) had a short-long-short sequence. These episodes invariably featured increased QT disperson. In 31 of 38 patients (82%), the ventricular tachycardias were always initiated by the same mode of onset. In eight patients, the monomorphic ventricular tachycardias were always triggered by short-long-short sequences. In seven patients, more than one onset mechanism was observed.
Two basic modes of onset were responsible for monomorphic ventricular tachycardia: one without RR-interval variations immediately prior to onset and another characterized by short-long-short sequences and increased QT dispersion. The mechanisms were largely patient-specific and not related to cardiac diagnosis or left ventricular function.
我们研究的目的是通过分析存储的心内电图来探究单形性室性心动过速的电触发模式，并识别植入心脏复律除颤器患者的血流动力学或心电图预测指标。
我们记录了38例至少发生三次事件的患者的286次单形性室性心动过速发作。通过室性心动过速前过早去极化的形态数量、复杂性和耦合间期来表征电触发因素。我们还评估了临床和心电图数据。
我们发现了两种基本的电触发模式。观察到216次事件（75%）在发作前无RR间期变化，而70次发作（25%）有短-长-短序列。这些发作总是伴有QT离散度增加。在38例患者中的31例（82%），室性心动过速总是由相同的发作模式起始。在8例患者中，单形性室性心动过速总是由短-长-短序列触发。在7例患者中，观察到不止一种起始机制。
两种基本的起始模式导致了单形性室性心动过速：一种在发作前无RR间期变化，另一种以短-长-短序列和QT离散度增加为特征。这些机制在很大程度上是患者特异性的，与心脏诊断或左心室功能无关。
