平板运动试验诱发缓慢心律失常的临床分析

Clinical analysis on bradyarrhythmia induced by treadmill exercise test

目的探讨平板运动试验(TET)后出现的缓慢心律失常能否作为对窦房结功能评价的依据。方法从TET后出现缓慢心律失常10例中筛选8例,应用Bruce或MOD-Bruce方案进行TET检查,以①运动中或运动停止后出现ST段水平型或下斜型下移≥0.1mV(于J点后80ms测量)且持续1min以上;②运动中或运动后出现ST段呈损伤缺血型抬高≥0.2mV为阳性标准,与冠状动脉照影(CAG)结果对照。结果TET6例为阳性,CAG4例为单纯右冠状动脉开口处狭窄,1例为双支病变,3例冠状动脉无明显狭窄(包括2例TET阴性者),缓慢心律失常均发生在运动终止后2min左右,表现为窦性心动过缓、窦性停搏、窦房阻滞、交接性逸搏心律。结论TET后出现缓慢心律失常与冠状动脉的病理基础有着密切关系,与个体的神经因素也有一定关系,能否用来评价窦房结功能尚需进一步探讨。

Objective To study the bradyarrhythmia which induced by treadmill exercise test can be the reference to the function of sinus node or not. Methods The exercise with Bruce or MOD - Bruce method was tested in selected 8 cases in 10 patients with bradyarrhythmia after treadmill exercise test. The following criteria was the positive results： 1. ST segment depression occurred in horizontal type or inferior oblique type ≥0. lmV （measured after J point 80ms） and sustained more than 1 minute during or after the test; 2. ST elevation in ischemic and injury type≥0.2mV during or after the test. The positive cases were compare with coronary angiography. Results Of the 8cases, 6 cases were positive in treadmill exercise test; coronary angiography indicated 4 cases had single stenosis at the entrance of right coronary artery, one case had double vessel disease, 3 cases had no obvious stenosis （including 2 cases, treadmill exercise test negative）. Bradyarrhythmia all occurred about 2 minutes after exercise, presenting sinus bradycardia, sinus arrest, sinus - atrium block and junctional escape rhythm. Conclusion The bradyarrhythmia after treadmill exercise test has a close relationship with coronary artery pathological variation, is also related to individual neural factors. Whether it can be the reference to the function of sinus node needs to be studied further.