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中华心血管病杂志 1990年第4期18卷 246-247页

作者：王化南林绍芳娄兹谟周聊生山东省千佛山医院内科

用异搏定治疗某些室性心动过速(室速)已受到关注。我们对2例Q-Tc正常,用异搏定有显效的室速患者做了临床心电生理检查(EPS),报告于下。例1 患者男,15岁。于1986年赛球中突感心慌.某院急诊心率210次/分。用普鲁卡因胺、心得安及升压药无... 详细信息

用异搏定治疗某些室性心动过速(室速)已受到关注。我们对2例Q-Tc正常,用异搏定有显效的室速患者做了临床心电生理检查(EPS),报告于下。例1 患者男,15岁。于1986年赛球中突感心慌.某院急诊心率210次/分。用普鲁卡因胺、心得安及升压药无效,持续9小时后予异搏定5mg静脉注射(静注)中终止。1987年2月又发作,加用利多卡因静注无效,持续达48小时中3次电击复律随即复发,又以异搏定5mg静注终止。转来我院,查体无阳性发现。化验血钾及T、T正常。心电图正常范围,Q-Tc 0.36s。停用异搏定观察至第9日又发作,心电

关键词：病例报告抗心律失常药/治疗应用维拉帕米/治疗应用心动过速室性/药物疗法人类

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Diastolic potentials in verapamil-sensitive ventricular tachycardia: True potentials or bystanders of the reentry circuits?

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AMERICAN HEART JOURNAL 1999年第3期138卷 560-566页

作者： Sato, M Sakurai, M Yotsukura, A Betsuyaku, T Ito, T Yoshida, I Kitabatake, A Hokkaido Univ Sch Med Dept Cardiovasc Med Kita Ku Sapporo Hokkaido 060 Japan

Background Diastolic potentials (DP) are reported to be recorded in intracardiac electrograms during verapamil-sensitive ventricular tachycardia (VT) in which QRS complexes show complete right bundle branch block with a superior axis. The purpose of this study was to ascertain whether the DP recorded in the endocardial mapping during VT reflects the activation of the VT circuit. Methods and Results The study group consisted of 16 men and 2 women. The earliest activation site (EA site) was determined and the DP was recorded in the endocardial mapping during VT. We evaluated the response of the cycle length of VT, the interval between the ventricular activation and the DP (V-DP), and the interval between the DP and the ventricular activation (DP-V) to intravenous verapamil. Radiofrequency current was delivered to the EA site, the site where the DP was recorded, and the site where the DP and the Purkinje fiber potential of the left bundle branch (LB) were simultaneously recorded. In 15 patients, the DP was recorded in the wide posterior fascicle region of the LB. After verapamil, the cycle length of VT, the V-DP, and the DP-V were prolonged from 365 +/- 53 to 490 +/- 65, 315 +/- 30 to 368 +/- 30, and 50 +/- 27 to 123 +/- 36 ms, respectively, in 6 patients. The LB was recorded in all patients and the DP was recorded preceding the LB in 12 patients. VT was successfully ablated at the site where the DP and the LB were simultaneously recorded in all these patients. Ablation at the other sites failed. Conclusions Radiofrequency ablation at the site where the DP was simultaneously recorded preceding the LB completely abolished the verapamil-sensitive VT. The DP recorded with the IB simultaneously might reflect the slow conduction zone activity of the reentry circuit located within the Purkinje fiber network.

关键词：抗心律失常药/药理学导管消融术心舒期心电描记术浦肯野纤维/生理学参考值心动过速室性/药物疗法心动过速室性/病理生理学心动过速室性/外科学维拉帕米/药理学青少年成年人女(雌)性人类男(雄)性中年人

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Comparison of dilated cardiomyopathy and coronary artery disease in patients with life-threatening ventricular arrhythmias: Differences in presentation and outcome in the AVID registry

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AMERICAN HEART JOURNAL 2001年第5期142卷 816-822页

作者： Ehlert, FA Cannom, DS Renfroe, EG Greene, HL Ledingham, R Mitchell, LB Anderson, JL Halperin, BD Herre, JM Luceri, RM Marinchak, RA Steinberg, JS Columbia Univ St Lukes Roosevelt Hosp Ctr Cardiol Sect New York NY 10019 USA Good Samaritan Hosp Los Angeles CA USA Univ Washington Seattle WA 98195 USA AVID Clin Trial Ctr Seattle WA USA Univ Calgary Calgary AB T2N 1N4 Canada Univ Utah Salt Lake City UT 84112 USA Oregon Hlth Sci Univ Portland OR 97201 USA Sentara Norfolk Gen Norfolk VA USA Florida Arrhythmia Consultants Ft Lauderdale FL USA Lankenau Hosp & Med Res Ctr Philadelphia PA USA

Background The etiology of structural heart disease in patients with life-threatening arrhythmias (ventricular tachycardia [VT]/ventricular fibrillation [VF]) may define clinical characteristics at presentation, may require that different therapies be administered, and may cause different mortality outcomes. Methods In the Antiarrhythmics Versus Implantable Defibrillators (AVID) registry, baseline clinical characteristics, treatments instituted, and ultimate mortality outcomes from the National Death Index were obtained on 3117 patients seen at participating institutions with VT/VF, irrespective of participation in the randomized trial. By use of these data, 2268 patients with coronary artery disease (CAD) were compared with 334 patients with dilated nonischemic cardiomyopathy (DCM). Results The CAD group was 7 years older and had a higher percentage of males. DCM patients were more likely to be African American, have severely compromised left ventricular function (52% vs 39%), and have a history of congestive heart failure symptoms (62% vs 44%). Patients with CAD were more likely to be treated with beta -blockers and calcium channel blockers and less likely to be treated with angiotensin-converting enzyme inhibitors. Patients with DCM were more likely to be treated with diuretics, warfarin, and an implantable cardioverter defibrillator for VT/VF (54% vs 48% for CAD);the use of other antiarrhythmic therapies did not differ between the 2 groups. Two-year survival was not significantly different between the groups (76.6% [95% CI 74.6%-78.7%] vs 78.2% [95% CI 73.6%-82.9%]). Conclusions In AVID registry patients with VT/VF, demographic and clinical characteristics were different between patients with CAD and those with DCM. Despite these differences, overall survival was similar in these 2 groups.

关键词：抗心律失常药/治疗应用心肌病扩张型/药物疗法心肌病扩张型/死亡率心肌病扩张型/治疗冠心病/药物疗法冠心病/死亡率冠心病/治疗除颤器植入型登记心动过速室性/药物疗法心动过速室性/死亡率心动过速室性/治疗心室颤动/药物疗法心室颤动/死亡率心室颤动/治疗人类

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Location of death (in-hospital or out-of-hospital) and type of death (arrhythmic, nonarrhythmic, noncardiac) after inducible sustained ventricular tachyarrhythmias after syncope, sustained ventricular tachycardia, or nonfatal cardiac arrest (The ESVEM Trial)

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第8期86卷 846-851页

作者： Olshansky, B Hartz, V Hahn, E Mason, J Weaver, MD Univ Iowa Hosp Iowa City IA 52242 USA Univ Arizona Dept Stat Tucson AZ USA Univ Kentucky Dept Med Lexington KY 40506 USA Henry Ford Hosp Div Cardiovasc Med Detroit MI 48202 USA

The ESVEM Trial evaluated methods to guide antiarrhythmic drug use in patients with spontaneous, inducible sustained tachyarrhythmias at electrophysiologic testing and frequent ventricular premature complexes (VPCs) per hour (greater than or equal to 10). We assessed the relation between location (in-hospital or out-of-hospital) and classification of death (arrhythmic, nonarrhythmic, cardiac and/or noncardiac) for 486 randomized patients. Deaths were classified as out-of-hospital arrhythmic deaths if arrhythmic death occurred out-of-hospital, or if an arrhythmia preceded hospital admission and directly caused death. Of the 486 randomized patients, 188 (39%) died during 6 years of follow-up. The location and type of death could be determined clearly in 171 patients (91%). Ninety-one deaths were in-hospital (53%);80 were out-of-hospital (47%). Arrhythmic deaths occurred in 85% out-of-hospital patients and in 30% in hospital patients (p <0.001). Baseline characteristics were comparable for patients with out-of-hospital and in-hospital arrhythmic deaths. Twenty-seven of 95 arrhythmic deaths occurred in-hospital (28%);72% occurred out-of-hospital. Out-of-hospital arrhythmic death accounted for 40% of deaths for which location and type of information were available. The 1- and 4-year actuarial out-of-hospital arrhythmic death rates were 9% and 18%, respectively. Of nonarrhythmic cardiac deaths, 91% were in-hospital and 9% were out-of-hospital. Of noncardiac deaths, 74% were in-hospital and 26% were out-of-hospital. Similar results were seen in the 296 patients for whom a drug was considered to be effective. Thus, over half the deaths in the ESVEM trial occurred in-hospital. The long-term actuarial risk of out-of-hospital arrhythmic death in ESVEM was unexpectedly low. (C) 2000 by Excerpta Medica, Inc.

关键词：保险统计分析抗心律失常药/治疗应用死亡原因心脏停搏/死亡率医院死亡率比例危险度模型晕厥/死亡率心动过速室性/药物疗法心动过速室性/死亡率美国/流行病学老年人女(雌)性人类男(雄)性中年人

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Demonstration of diastolic and presystolic Purkinje potentials as critical potentials in a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第3期36卷 811-823页

作者： Nogami, A Naito, S Tada, H Taniguchi, K Okamoto, Y Nishimura, S Yamauchi, Y Aonuma, K Goya, M Iesaka, Y Hiroe, M Yokohama Rosai Hosp Div Cardiol Kohoku Ku Yokohama Kanagawa 2220036 Japan Gunma Prefectural Cardiovasc Ctr Div Cardiol Maebashi Gumma Japan Yokosuka Kyosai Gen Hosp Div Cardiol Yokosuka Kanagawa Japan Tsuchiura Kyodo Gen Hosp Cardiovasc Ctr Tsuchiura Ibaraki Japan Tokyo Med & Dent Univ Dept Med 2 Tokyo Japan

OBJECTIVES The purpose of this study was to determine the relation of diastolic and presystolic potentials recorded during verapamil-sensitive idiopathic left ventricular tachycardia (ILVT) to reentry circuit. BACKGROUNDS Successful ablation of verapamil-sensitive ILVT at the zone of slow conduction from which the diastolic potential is recorded has been reported. However, the relationship between the diastolic potential and the reentrant circuit remains a matter of debate. METHODS Radiofrequency (RF) ablation was performed in 20 patients with verapamil-sensitive ILVT. After identifying the ventricular tachycardia (VT) exit site, we searched for the mid-diastolic potential(P1) during VT. Entrainment followed by RF current application was performed. Ii the mid-diastolic potential could not be detected, RF current was applied at the VT exit site showing the earliest ventricular activation with a single fused presystolic Purkinje potential (P2). RESULTS In 15 of 20 patients, both P1 and P2 were recorded during VT from midseptal region. Entrainment pacing captured P1 orthodromically and reset the VT. The interval from stimulus to P1 was prolonged as the pacing rate was increased. Radiofrequency ablation was successfully performed at this site in all 15 patients. After successful ablation, P1 appeared after the QRS complex during sinus rhythm with the identical sequence to that during VT. In the remaining five patients, the diastolic potential could not be detected, and a single fused P2 was recorded only at the VT exit site. Successful ablation was performed at this site in all five patients. CONCLUSIONS This study demonstrates that P1 and P2 are critical potentials in a circuit of verapamil-sensitive ILVT and suggests the presence of a macroreentry circuit involving the normal Purkinje system and the abnormal Purkinje tissue with decremental property and verapamil-sensitivity, (C) 2000 by the American College of Cardiology.

关键词：抗心律失常药/治疗应用导管消融术心舒期心电描记术电生理学心内膜/病理生理学手术后期间浦肯野纤维/病理生理学心缩期心动过速室性/药物疗法心动过速室性/病理生理学心动过速室性/外科学心室功能左/药物作用维拉帕米/治疗应用青少年成年人老年人儿童女(雌)性人类男(雄)性中年人

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Clusters of ventricular tachycardias signify impaired survival in patients with idiopathic dilated cardiomyopathy and implantable cardioverter defibrillators

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第2期36卷 566-573页

作者： Bänsch, D Böcker, D Brunn, J Weber, M Breithardt, G Block, M St George Hosp Dept Cardiol D-20099 Hamburg Germany Univ Munster Dept Cardiol D-4400 Munster Germany Univ Munster Inst Arteriosclerosis Res D-4400 Munster Germany

OBJECTIVES This retrospective study was undertaken to provide data on occurrence, significance and therapy of ventricular tachyarrhythmia (VT) dusters (VTCs) in patients with dilated cardiomyopathy (DCM) and implantable cardioverter defibrillators (ICDs). BACKGROUND Data on the clinical significance of VTCs are lacking in patients with DCM and ICDs. METHODS Baseline characteristics of 106 consecutive patients with DCM and ICDs were prospectively collected, and chart reviews and episode data retrospectively analyzed. A VTC was defined as greater than or equal to 3 sustained VTs/24 h. RESULTS During a mean follow-up of 33 +/- 23 months, 73 patients (68.9%) had recurrent VT or ventricular fibrillation (VF), 43 patients (40.6%) suffered only single VTs and 30 patients (28.3%) experienced 52 clusters of VTs. Actuarial survival free of VT or VF tvas 44.6%, 33.0%, and 26.5%, and survival free of VTC was 77.3%, 72.2% and 67.1% after one, two and three years, respectively. Independent predictors of VT dusters were heart failure before ICD implantation (p = 0.033), presenting monomorphic VT (p = 0.044), EF <0.40 (p = 0.014) and inducible mVT, especially with right bundle branch block and superior axis configuration (p < 0.001). Survival free of recurrent VTCs was 50.8%, 38.1% and 19.0%, after one, two and three years, respectively. Once a VTC had occurred, only 56.7%, 46.4%, 30.9% and 15.5% of patients survived and were not transplanted after one, two, three and four years, respectively. Survival tvas even more reduced ifa VTC was associated with cardiac decompensation: 65.6%, and 21.9%, after one and two years, respectively. CONCLUSIONS Despite antiarrhythmic intervention, clusters of VTs occur and recur frequently in patients with DCM. They signify impaired survival, especially if they are associated with cardiac decompensation, and may be a harbinger of progressive myocardial deterioration rather than a primarily arrhythmic problem. The benefit of ICD therapy may therefore

关键词：胺碘酮/治疗应用抗心律失常药/治疗应用心肌病扩张型/并发症心肌病扩张型/死亡率除颤器植入型心脏移植预后回归分析回顾性研究索他洛尔/治疗应用存活率分析心动过速室性/并发症心动过速室性/药物疗法心动过速室性/治疗老年人人类中年人

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Familial polymorphic ventricular arrhythmias - A quarter century of successful medical treatment based on serial exercise-pharmacologic testing

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第7期34卷 2015-2022页

作者： Fisher, JD Krikler, D Hallidie-Smith, KA Hammersmith Hosp Royal Postgrad Med Sch Div Cardiovasc Dis London England

OBJECTIVES We sought to determine whether objective tests of antiarrhythmic drug efficacy could produce favorable short- and long-term outcomes in a family with idiopathic malignant ventricular arrhythmias. BACKGROUND In 1973 a family presented with a history of several generations of syncopal spells and sudden death. Some individuals had nonspecific electrocardiographic (ECG) changes. Their QT intervals were normal at rest and with exercise. Autopsies in two young family members showed no cardiac abnormalities, specifically no evidence of arrhythmogenic right ventricular dysplasia, other cardiomyopathy, myocarditis or gross abnormality of the conduction system. METHODS Available family members had screening ECGs. Symptomatic members had a battery of tests, including electrophysiologic studies, ambulatory ECGs, audiograms, exercise stress testing, serum catecholamine levels during rest and exercise and isoproterenol infusion. Serial exercise-pharmacologic testing was performed in symptomatic family members until induction of an arrhythmia during exercise required higher work loads or became impossible. RESULTS Arrhythmias were not induced during electrophysiologic studies. In several family members tested, ventricular premature beats and then rapid polymorphic ventricular arrhythmias occurred whenever the sinus rate exceeded 130 beats/min. Emotional stress, isoproterenol infusion and exercise all elicited similar arrhythmias. Catecholamine levels during exercise were, however, unequivocally normal in two of three family members tested. Beta-blockers appeared to be the most effective pharmacologic agent for prevention of these arrhythmias. The efficacy of treatment has been confirmed during a follow-up of 25 years. CONCLUSIONS This family appears to have catecholamine hypersensitivity as the basis for their ventricular arrhythmias. Guided therapy using serial exercise-pharmacologic testing provided reliable protection for this familial ventricular arrhythmia during a

关键词：肾上腺素能β激动剂肾上腺素能β受体拮抗剂/投药和剂量肾上腺素能β受体拮抗剂/治疗应用抗心律失常药/投药和剂量抗心律失常药/治疗应用抗惊厥药/投药和剂量抗惊厥药/治疗应用儿茶酚胺类/血液投药途径超声心动描记术心电描记术便携式运动试验随访研究心室/诊断显像心室/病理学异丙肾上腺素系谱苯妥英/投药和剂量苯妥英/治疗应用普萘洛尔/投药和剂量普萘洛尔/治疗应用回顾性研究心动过速室性/血液心动过速室性/诊断心动过速室性/药物疗法心动过速室性/遗传学治疗结果维拉帕米/投药和剂量维拉帕米/治疗应用青少年成年人儿童女(雌)性人类男(雄)性中年人

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Irregular rhythm after cardiac surgery

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HOSPITAL PRACTICE 1999年第13期34卷 27-28页

作者： Hancock, EW Stanford Univ Sch Med Stanford CA 94305 USA

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关键词：抗心律失常药/治疗应用主动脉瘤胸/外科学心电描记术心脏传导阻滞/诊断心脏传导阻滞/病因学利多卡因/治疗应用手术后并发症/病因学心动过速室性/药物疗法成年人人类男(雄)性

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Adenosine-responsive wide QRS complex tachycardia: What is the mechanism?

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JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY 1999年第12期10卷 1688-1689页

作者： Oral, H Michaud, GF Morady, F Univ Michigan Med Ctr Div Cardiol Dept Internal Med Ann Arbor MI 48109 USA

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Efficacy of Bretylium tosylate for ventricular tachycardia

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第1期83卷 115-+页

作者： Chandrasekaran, S Steinberg, JS Columbia Univ Coll Phys & Surg St Lukes Roosevelt Hosp Ctr Dept MedDiv Cardiol New York NY 10025 USA

In 20 patients with inducible Ventricular tachycardia (VT), intravenous bretylium tosylate infused as a 10-mg/kg bolus followed by 2 mg/min caused no change in refractory periods and did not suppress inducibility of V... 详细信息

关键词：抗心律失常药/治疗应用溴苄铵托西酸盐/治疗应用低血压/化学诱导前瞻性研究疾病严重程度指数晕厥/病因学晕厥/病理生理学晕厥/预防和控制心动过速室性/并发症心动过速室性/药物疗法心动过速室性/病理生理学治疗失败女(雌)性人类男(雄)性中年人

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