恶性快速性室性心律失常致心源性晕厥的临床观察

Cardiac syncope caused by malignant rapid ventricular arrhythmia

目的探讨恶性快速性室性心律失常致心源性晕厥的病因与高危心电图表现。方法分析48例在入院时或入院后至少发生1次心源性晕厥患者的病因及其发作时与发作前后的常规12导联心电图或持续心电监护心电图形。结果48例恶性快速性心律失常致心源性晕厥最常见的基本病因为急性冠心病或陈旧性心肌梗死,其次为扩张型和肥厚型心肌病及其他病因;低钾血症是最常见的诱因;最常见的恶性快速性室性心律失常类型是尖端扭转型室性心动过速。其高危心电图表现:继发性长QT间期综合征;Brugada综合征;异常J波;复杂性室性早搏;急性心肌梗死伴ST-T电交替,或广泛前壁心肌梗死伴墓碑样ST段抬高;扩张型心肌病伴进展性QRS波群低电压。上述各种病因心源性晕厥者有各自不同的临床及心电学特征。结论恶性快速性室性心律失常所致心源性晕厥存在多种病因及高危心电图表现。

Objective To explore causes and high risk electrocardiogram expression of cardiac syncope caused by malignant rapid ventricular arrhythmia. Methods Forty-eight patients were analysed, they had cardiac syncope once or more that after which were admitted to the hospital. Results The basic causes of cardiac syncope were individed following types in 48 patients： coronary heart disease with acute or dated myocardial infarction, dilated or hypertrophic cardiomyopathy,hypokalaemia were ordinarist inducer. Torsade de pointes（TdP） were most common type of malignant rapid ventricular arrhythmia. They had some high risk electrocardiogram expression： secondary long QT syndrome, Brugada＇s syndrome, idiopathic abnormal J wave, complex ventricular ectopic beats, acute myocardial infarction with ST-T electrical alternation ; or extensive anterior myocardial infarction with tombstone ST segment elevation, dilated cardiomyopathy with advance QRS complex low voltage. They were different electrocardiographic and chnical characteristic. Conclusion The cardiac syncope caused by malignant rapid ventricular arrhythmia is not single and independent clinical entity, which presents different the causes and high risk electrocardiogram expression.