由冠状动脉痉挛引起的心律失常的处理及随访

Management of arrhythmia induced by coronary artery spasm.

目的探讨由冠状动脉(简称冠脉)痉挛引起心律失常的处理方法及有效性。方法8例晕厥发作时心电图提示下壁导联ST段抬高伴完全性房室传导阻滞,2例胸闷继发黑矇,无症状发作时心电图正常。明确无水、电解质紊乱后,予以心脏超声、动态心电图、心电监护、冠脉造影检查,明确诊断和病因后予以相应的处理。结果10例生化及心脏超声正常。8例发作性Ⅲ度房室传导阻滞入院的患者,除1例发现右冠脉开口狭窄20%～30%外,其余患者冠脉造影均正常,均置入单腔心室起搏器后使用钙拮抗剂。2例胸闷伴黑矇患者中的1例,造影前Holter发现V1～V6导联ST段抬高伴短阵室性心动过速(简称室速),冠脉造影发现左前降支近段粥样斑块形成,狭窄程度<50%,考虑室速发生的原因是粥样斑块基础上痉挛所致,直接支架植入。另1例造影前无症状发作,造影发现左前降支近段粥样斑块形成,狭窄程度<50%,未予干预,当晚患者症状再发,心电监护发现V1～V6导联ST段抬高伴短阵室速,考虑室速发生的原因与上相同,急诊植入支架。所有患者随访6月至11年,均健在,无类似发作,生活状况良好。结论对于冠脉痉挛引起的心律失常,针对其病变基础采用稳定斑块、起搏支持下的抗痉挛治疗有效。

Objective To report the effect of management of arrhythmia induced by coronary artery spasm. Method Ten patients with syncope or pre-syncope were enrolled in the study, eight patients with complete atrial-ventricular block and inferior ST segment elevation with no-evidence to make the diagnosis clear in the other two patients. All patients ac- cepted the arrhythmia monitoring and coronary angiography （CAG）. Results All patients had normal electrolyte and heart structure. Eight patients had normal CAG, the combination of pacemakers implantation and Ca2 ＋ channel antagonist a- gents were used in them. The other two patients without diagnostic evidence had V1-V6 ST segment elevation followed by ventricular tachycardia. CAG showed plaque less than 50% in left anterior descending artery, and stents were implanted in the spasm-relative artery. Result of follow-up for period of 6mo-1 lyr showed all were alive without syncope or pre-syncope. Conclusion Methods to focus on unstable plaque and coronary spasm under pacemaker backup are effective. [ Chinese Journal of Cardiac Pacing and Electrophysiology ,2008 ,22 （ 5 ） ： 388 - 390 ]