24h动态心电图结合阿托品试验预测窦性心动过缓患者猝死风险

24h Holter monitoring combined with atropine test in predicting the risk of sinus Bradycardia leading to sudden death

目的对窦性心动过缓(SN)患者作24 h动态心电图(Holter)检查,结尾时连接作阿托品激发窦房结试验,分析窦房结功能以进行猝死风险预测。方法选择近4年来因各种原因未能安装心脏永久性起博器之SN患者43例,控制心功能在Ⅱ级以内,剔除房性、交界性和室性传导阻滞、Brugada综合征J、波综合征者。经24 h Holter检查延长1 h,静脉推注阿托品1.5～2.0 mg,记录1 h内最大心率变化,结合Holter最慢时间段心率判断SN患者猝死可能。结果在43例SN患者中,Holter反应出最低时间的心率<45次/min有11例;40～60次/min有32例。在Holter结尾1 h阿托品激发试验中,最大心率<85次/min阳性,>85次/min为阴性,识别出猝死的高危、中危、低危人群。在此3组患者中总死亡人数为9例,占43例SN患者病死率20%,组间存在着不同的病死率。结论窦性心动过缓患者最慢心率60次/min以下,Holter连接阿托品激发窦房结功能试验,1 h最大心率<85次/min为高危患者,4年内发生猝死可能性为83.3%,需安装永久性起搏器,以预防猝死发生。

Objective To analyze the function of sinus node（SN） and to predict sudden death by combined using of 24h dynamic electrocardiography（Holter） and atropine testing.Methods 43 patients with sinus bradycardia and without implantation of permanent pacemaker were selected for study.The cardiac function of all patients were ≤NYHA Ⅱ,excluding supraventricular and ventricular block,Brugada syndrome and J wave syndrome cases.The 24h Holter examination was taken with extension of one more hour.1.5-2.0 mg of atropine were intravenously injected.The maximum heart rate within 1 hour was recorded.Combining with the slowest heart rate in Holter examination to forecast the sudden death possibility of SN patients.Results According to the results of Holter testing,there were 11 patients＇ heart rate 45 bpm,32 patients＇ heart rate between 40 and 60 bpm.All patients were divided into high,middle and low-risk groups according to the results atropine testing.9 cases of 43 patients were dead with the mortality about 20%.The mortality was significantly different among the groups.Conclusion The the sudden death probability within 4 years of patients with high-risk mortality was 83.3%.These high-risk patients should be implanted with permanent pacemaker to prevent sudden cardiac death.