变异型心绞痛诱发严重心律失常

Critical Arrhythmias in Patients With Variant Angina

６例变异型心绞痛（ＶＡ）患者于胸痛发作时经１２导联和（或）２４ｈ动态心电图记录到心律失常。其中心绞痛发作时伴发室性早搏二联律３例、短阵室性心动过速１例、Ⅲ度房室阻滞（ＡＶＢ）２例。１例Ⅲ度ＡＶＢ者伴有发作性晕厥。冠状动脉造影提示与缺血有关的冠状动脉狭窄３例；余３例冠脉造影结果大致正常，但麦角新碱激发试验均为阳性。２例行药物治疗，３例接受经皮冠状动脉腔内成形术治疗，１例Ⅲ度ＡＶＢ伴晕厥者置入永久性人工心脏起搏器。结果表明冠状动脉痉挛在ＶＡ患者致命性心律失常的发生中具有重要作用。

Critical arrhythmia was detected by either 12lead or 24hour ambulatory electrocardiography during the episode of chest pain in 6 patients with variant angina (VA) including frequent ventricular premature beat in 3 patients,paroxysmal ventricular tachycardia in 1 patient,and third degree atrioventricular block (AVB) in 2 patients.Cardiac syncope history was recorded in a patient with third degree AVB.Significant coronary stenosis related to ischemic zone was uncovered in 3 patients,and coronary spasm induced by ergonovine was demonstrated in other 3 patients.2 patients were recovered following drug therapy,3 patients were performed percutaneous transluminal coronary angioplasty,and 1 patient with AVB companied with syncope induced by coronary spasm was treated with permanent pacemaker implantation.The current report indicats that coronary spasm play an important role in lifethreaten arrhythmia in patients with VA.