Englund A, Bergfeldt L, Rosenqvist M
Department of Cardiology, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.
Pacing Clin Electrophysiol. 1998 Oct;21(10):1979-87. doi: 10.1111/j.1540-8159.1998.tb00017.x.
This literature review, based mainly on the English-language literature, focuses on pharmacological stress testing of the His-Purkinje system as part of an invasive electrophysiological study. The main target group for this investigation is patients with bifascicular block and syncope in which intermittent high grade AV block is suspected. Several drugs have been used for this purpose, mainly Class I antiarrhythmic agents such as ajmaline, procainamide, disopyramide, and flecainide. Most studies, unfortunately, suffer from limited patient numbers, lack of adequate control groups, and/or adequate follow-up. The sensitivity of the disopyramide stress test has been shown to be 75%-100% for prediction of impending high grade AV block. The specificity was > 90%. Studies on procainamide have shown a sensitivity of 60% but the specificity has not been assessed. There are no studies allowing a strict comparison of the diagnostic value of pharmacological provocation with different drugs. Based on the similarities of the electrophysiological effects on the His-Purkinje system of the above Class I agents, it is reasonable to assume that all of them might be of diagnostic value in the present clinical context, provided atrial and ventricular stimulation after drug is included in the protocol.
本综述主要基于英文文献，聚焦于作为侵入性电生理研究一部分的希氏-浦肯野系统的药物应激试验。本研究的主要目标人群是怀疑有间歇性高度房室传导阻滞的双分支阻滞合并晕厥患者。已有多种药物用于此目的，主要是Ⅰ类抗心律失常药，如阿义马林、普鲁卡因胺、丙吡胺和氟卡尼。遗憾的是，大多数研究存在患者数量有限、缺乏足够对照组和/或充分随访的问题。丙吡胺应激试验预测即将发生高度房室传导阻滞的敏感性已被证明为75%-100%。特异性>90%。关于普鲁卡因胺的研究显示敏感性为60%，但尚未评估其特异性。尚无研究能够严格比较不同药物药理学激发试验的诊断价值。基于上述Ⅰ类药物对希氏-浦肯野系统电生理效应的相似性，合理的假设是，在当前临床背景下，只要试验方案中包括用药后的心房和心室刺激，所有这些药物可能都具有诊断价值。
