CAJ | 학술논문

目的：研究健康人中Ⅰ度及Ⅱ度一型房室传导阻滞的病因、临床特点及预后。方法对2000~2011年常规心电图发现Ⅰ度及Ⅱ度一型房室传导阻滞、并经各项临床检查证实无器质性心脏病且年龄小于35岁者进行前瞻性研究，研究包括临床症状、心电图特点、房室结电生理特性，并对其中部分病例进行了随访。结果①共40例（男性28例，女性12例；年龄9~35岁，平均年龄26.2±7.9岁）进入本研究，其中仅表现为Ⅰ度房室传导阻滞者14例，兼有Ⅰ度及Ⅱ度文氏型房室传导阻滞者26例；房室传导阻滞均为间歇性发作。②28例无与房室传导阻滞相关的临床症状；12例有发作性胸闷，其中2例胸闷时心电图为PR过长（>0.28 s），7例为Ⅱ度文氏型房室传导阻滞（其中6例伴窦缓），另3例未发现与胸闷相关的心电图异常。③38例进行了房室传导功能检查：38例基础状况下房室前传功能减退，使用阿托品后36例完全恢复正常，1例出现2：1房室阻滞；38例中24例出现房室结双径路传导现象。④对25例进行3~10年的随访观察，未见有临床症状及房室传导阻滞加重的倾向。结论25例的长期随访说明健康人Ⅰ度及Ⅱ度一型房室阻滞的预后良好。
목적：연구건강인중Ⅰ도급Ⅱ도일형방실전도조체적병인、림상특점급예후。방법대2000~2011년상규심전도발현Ⅰ도급Ⅱ도일형방실전도조체、병경각항림상검사증실무기질성심장병차년령소우35세자진행전첨성연구，연구포괄림상증상、심전도특점、방실결전생리특성，병대기중부분병례진행료수방。결과①공40례（남성28례，녀성12례；년령9~35세，평균년령26.2±7.9세）진입본연구，기중부표현위Ⅰ도방실전도조체자14례，겸유Ⅰ도급Ⅱ도문씨형방실전도조체자26례；방실전도조체균위간헐성발작。②28례무여방실전도조체상관적림상증상；12례유발작성흉민，기중2례흉민시심전도위PR과장（>0.28 s），7례위Ⅱ도문씨형방실전도조체（기중6례반두완），령3례미발현여흉민상관적심전도이상。③38례진행료방실전도공능검사：38례기출상황하방실전전공능감퇴，사용아탁품후36례완전회복정상，1례출현2：1방실조체；38례중24례출현방실결쌍경로전도현상。④대25례진행3~10년적수방관찰，미견유림상증상급방실전도조체가중적경향。결론25례적장기수방설명건강인Ⅰ도급Ⅱ도일형방실조체적예후량호。
Objective Tostudytheetiologyandclinicalcharacteristicsoffirst-degreeandtypeIsecond-degreeatrioventricularblock (AVB)inhealthyindividuals.Methods Fortycasesoffirst-degreeAVBand/ortypeIsecond-degreeAVBscreenedbyroutineelectrocardio-gram( ECG)between 2000 and 2011 were included in this study. All the cases were under 35 and had no organic heart disease. The clinical symptoms,ECG and electrophysiological properties of atrioventricular node were investigated. Results ①The mean age of 40 cases(male 28,fe-male12)was26.2±7.9years. Of40cases,14hadfirst-degreeAVBandothersweresecond-degreeAVB(typeI);andallcaseshadinter-mittent AVB. ②28 cases were asymptomatic,12 had chest distress. Of these 12 cases,2 had a long PR interval( >0. 28 s),7 had second-de-gree AVB(type I)(6 had sinus bradycardia),3 had normal ECG. ③38 cases underwent cardiac electrophysiology study. Forward conduction function of atrioventricular decreased in 38 cases,after using atropine the function recovered to normal in 36 cases,but had 2:1 AVB in one case. Dual A-V nodal pathways conduction phenomenon was found in 24 cases. ④25 cases were followed-up for 3~10 years,no evidence showed thattherewasatendencytowardaggravationofclinicalsymptomsand/orthedegreeofAVB.Conclusion Ourlong-termfollow-upof25cases suggested that first-degree AVB and type I second-degree AVB could have a favourable prognosis in healthy individuals.