急性下壁心肌梗死急诊PCI时临时起搏对恶性室性心律失常的影响

目的回顾性分析急性下壁心肌梗死（简称急性下壁心梗）接受急诊经皮冠状动脉介入治疗（PCI）的住院患者多项临床资料，探讨临时起搏对恶性室性心律失常（引起血流动力学异常的室速、室颤）的影响。方法收集急性下壁心梗且成功完成急诊PCI的219例住院患者的资料，其中未行临时起搏158例，行临时起搏61例。将起搏前心率（HR）≥50次／min且在再灌注前起搏者定为保护性临时起搏，共45例；保护性临时起搏患者为保护性起搏组；未行临时起搏患者为非起搏组。观察患者的一般临床特征、冠脉病变特点、再灌注后恶性室性心律失常的发生情况，以及住院期间恶性室性心律失常发生情况。结果保护性起搏组室速、室颤的发生率高于非起搏组（17．78％比3．16％，P〈0．05）。Logistic回归分析结果示，RR--exp（-3．430＋1．748xl＋0．041x2），保护性起搏为发生室速室颤的危险因素（P〈0．01），保护性起搏发生室速、室颤危险度较非起搏高5．74倍。结论保护性临时起搏有增加急性下壁心梗急诊PCI患者恶性室性心律失常发生的风险。保护性临时起搏无预防或减少再灌注恶性室性心律失常发生的作用。

The effects of temporary cardiac pacing on malignant ventricular arrhythmia in the patients with acute inferior wall myocardial infarction during emergency PCI

Objective This study retrospectively analyzed the multiple clinical data of the inpatients with acute inferior wall myocardiac infarction who underwent emergency percutaneous coronary intervention （PCI）. To investigate the effects of temporary cardiac pacing on malignant ventricular arrhythmia （ventricular fibrillation and ventricular tachycardia with unstable hemodynamics）. Methods Of the 219 inpatients with acute inferior wall myocardiac infarction who underwent successful emergency PCI. 158 patients did not undergo temporary cardiac pacing, 61 patients underwent temporary cardiac pacing. The group of patients （45 cases） with HR（heart rate ）≥ 50 beats/min who underwent pre-reperfusion cardiac pacing were categorized as preventive temporary cardiac pacing group. The group of patients who did not undergo cardiac pacing was categorized as non-cardiac pacing group. The general clinical manifestations, coronary artery pathologic features and the occurrence of malignant ventricular arrhythmia during cardiac pacing were observed. Results The occurrence rate of ventricular tachycardia and ventricular fibrillation was higher in the preventive cardiac pacing group than the non-cardiac pacing group （17.78% vs 3.16%, P〈0.05）. The Logistic regression analysis revealed that RR=exp （-3.430＋1.748xl＋0.041x2）. The preventive cardiac pacing was a risk factor of ventricular tachycardia and ventricular fibrillation（P〈0.01 ）. The risk was 5.74 times higher in the preventive cardiac pacing group than the non-cardiac pacing group. Conclusion Temporary cardiac pacing may increase the risk of malignant ventricular arrhythmia in patients with acute inferior wall MI undergoing emergency PCI. It can not prevent or decrease the occurrence of malignant ventricular arrhythmia.