摘要
目的分析快速性心律失常终止后出现长时间窦性停搏的电生理特征。方法观察有快速性心律失常终止后出现长时间窦性停搏（〉3S）的25例患者，25例患者根据年龄分为2组，≤60岁14例（中青年组），〉60岁11例（老年组）。对这些患者行导管消融治疗，在消融前后行心内电生理检查。在消融术后的1、3、6、12和24个月行动态心电图检查。结果25例患者中，12例为房室折返性心动过速（AVRT），2例为房室结折返性心动过速（AVNRT），3例为房性心动过速，3例为Ⅰ型心房扑动（房扑），5例为阵发性心房颤动（房颤）。在快速性心律失常终止时，记录到窦性停搏时间为3．2～9．4（5．6±2．7）s。窦房结恢复时间（SNRT），矫正SNRT及窦房传导时间（SACT）等在两组间差异无统计学意义（P〉0．05）。两组患者消融前后的心内电生理检查比较发现，中青组患者消融前后，SNRT、矫正的SNRT及SACT差异均无统计学意义（P〉0．05）。老年组患者消融前后，SNRT差异有统计学意义（P〈0．05），而矫正的SNRT及SACT差异无统计学意义（P〉0．05）。23例患者射频消融术成功后未再发心动过速，也没有出现〉3s的窦性停搏。1例持续性房扑患者在射频消融术后半个月，房扑反复发作并在终止时出现长时间的窦性停搏并伴晕厥，植入永久性心脏起搏器。1例阵发性房颤患者在术后仍有房颤间断发作，房颤终止时仍有窦性停搏现象，但停搏时间〈3s，并且没有晕厥或近似晕厥的症状。结论快速心律失常后出现窦性停搏患者的窦房结功能大多是正常的，消融治疗快速性心律失常后患者心律失常相关的窦性停搏随之消失了，如果患者存在窦房结病变，则可考虑植入永久性心脏起搏器。
Objective To study the electrophysiological characteristics of prolonged sinus pauses on termination of taehyarrhythmia. Methods Twenty-five patients with prolonged sinus pauses （ 〉3 s ） on termi-nation of tachyarrhythmia were enrolled. These patients were treated with radiofrequeney ablation following intra-cardial electrophysiologieal testing （EPT）. After successful ablation, these patients were clinically reevaluated at 1, 3,6,12 and 24 months by Holter. Results Radiofrequency ablation was successful in 25 cases, 12 pa-tients with atrioventrieular reentrant tachycardia（ AVRT）, 2 patients with atrioventricular nodal reentrant taehy-eardia（ AVNRT）, 3 cases with atrial taehyeardia, 3 patients with type I atrial flutter, and 5 patients with par-oxysmal atrial fibrillation（AF）. Documented prolonged sinus pauses were found on termination of tachyarrhyth- mia, ranging from 3.2 to 9.4 s （5.6 ± 2. 7） s. Twenty-five patients were divided into two groups according to age, 14 cases in young group, 11 cases in elderly group. SNRT, corrected SNRT and SACT were no significant difference between the two groups （P〉0. 05）. There were no significant changes of SNRT and corrected SNRT and SACT in the young group before and after ablation（ P〉0. 05 ）. But in the elderly group, SNRT showed sig-nificant changes （P〈0. 05 ） after ablation, and corrected SNRT and SACT was no significant change（P〉0. 05）.No sinus pauses more than 3 s were observed by ambulatory monitoring in 23 patients after successful RFCA. One case with persistent atrial flutter had the event of episodes of AF and permanent cardiac pacemaker was im-planted. One patient with paroxysmal AF had sinus pauses on termination of tachyarrhythmia post-ablation, the sinus pauses were less than 3 s without symptoms of syncope or presyncope. Conclusions Prolonged sinus pauses on termination of tachyarrhythmia was reversible, most of the patients had normal sinus node function, and the sinus pauses disappeared after successful catheter ablation of arrhythmias. If patient had sick sinus node, a permanent pacemaker implantation should be considered.
出处
《中华心律失常学杂志》
2012年第6期446-449,共4页
Chinese Journal of Cardiac Arrhythmias
