CAJ | 학술논문

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(＞3 s)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＞3 s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＜3 s,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.
목적 분석쾌속성심률실상종지후출현장시간두성정박적전생리특정.방법 관찰유쾌속성심률실상종지후출현장시간두성정박(＞3 s)적25례환자,25례환자근거년령분위2조,≤60세14례(중청년조),＞60세11례(노년조).대저사환자행도관소융치료,재소융전후행심내전생리검사.재소융술후적1、3、6、12화24개월행동태심전도검사.결과 25례환자중,12례위방실절반성심동과속(AVRT),2례위방실결절반성심동과속(AVNRT),3례위방성심동과속,3례위Ⅰ형심방복동(방복),5례위진발성심방전동(방전).재쾌속성심률실상종지시,기록도두성정박시간위3.2 ～9.4(5.6±2.7)s.두방결회복시간(SNRT),교정SNRT급두방전도시간(SACT)등재량조간차이무통계학의의(P＞0.05).량조환자소융전후적심내전생리검사비교발현,중청조환자소융전후,SNRT、교정적SNRT급SACT차이균무통계학의의(P＞0.05).노년조환자소융전후,SNRT차이유통계학의의(P＜0.05),이교정적SNRT급SACT차이무통계학의의(P＞0.05).23례환자사빈소융술성공후미재발심동과속,야몰유출현＞3 s적두성정박.1례지속성방복환자재사빈소융술후반개월,방복반복발작병재종지시출현장시간적두성정박병반훈궐,식입영구성심장기박기.1례진발성방전환자재술후잉유방전간단발작,방전종지시잉유두성정박현상,단정박시간＜3 s,병차몰유훈궐혹근사훈궐적증상.결론 쾌속심률실상후출현두성정박환자적두방결공능대다시정상적,소융치료쾌속성심률실상후환자심률실상상관적두성정박수지소실료,여과환자존재두방결병변,칙가고필식입영구성심장기박기.
Objective To study the electrophysiological characteristics of prolonged sinus pauses on termination of tachyarrhythmia.Methods Twenty-five patients with prolonged sinus pauses (＞3 s) on termination of tachyarrhythmia were enrolled.These patients were treated with radiofrequency ablation following intracardial electrophysiological 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 patients with atrioventricular reentrant tachycardia(AVRT),2 patients with atrioventricular nodal reentrant tachycardia(AVNRT),3 cases with atrial tachycardia,3 patients with type Ⅰ atrial flutter,and 5 patients with paroxysmal atrial fibrillation(AF).Documented prolonged sinus pauses were found on termination of tachyarrhythmia,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 significant 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 implanted.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.