变异型心绞痛发作时心律失常的发生与冠状动脉病变的关系

The relations between arrhythmias occurred in variant angina attack and coronary artery lesions

目的 探讨变异型心绞痛（VA）患者,心律失常的发生与冠状动脉病变的关系。方法临床观察88例VA患者,均采用18导联心电图和CM5和CMaVF导联系统进行24h监测（Holtermonitoring）,全部患者进行冠状动脉造影检查,以确定有无冠状动脉病变和病变的部位。结果48例伴有心律失常的VA患者中,冠状动脉存在固定性狭窄（≥50％）者 29例,占心律失常患者的60.4％,冠状动脉狭窄<50％者占39.6％。狭窄在50％～74％者占31.3％,狭窄在75％～90％者占22.9％,>90％的狭窄占6.3％。而在40例无心律失常的患者中,冠状动脉存在固定性狭窄者为27例,占元心律失常患者的67.5％。结论 VA患者其心律失常的发生与冠状动脉病变的有无和严重程度无明显的正相关（P>0.05）。室性心动过速和心室颤动,可以伴发于左或右冠状动脉痉挛,但高度房室阻滞,则主要发生于右冠状动脉痉挛。

Objective To assess the relations between arrhythmias occurred in variant angina (VA) attack and coronary artery lesions. Methods Eighty-eight patients with VA had undergone 18-lead electrocardiograms/Holter monitoring and coronary arteriography (CAG) to confirm the existence of coronary lesions and the position of lesions.Results Of 48 VA patients accompanied with arrhythmias,29 patients (60.4%) had fixed stenosis (≥50%).19 patients (39.6%) had <50% stenosis.There were 31.3% patients had 50% -74% stenosis,22.9% patients 75% -90% ,and 6.3% patients>90% . Of 40 patients without arrhythmias 27 patients had fixed stenosis (67.5%).Conclusion There was no significant positive correlation between arrhythmia occurrence and coronary artery lesion in VA patients (P>0.05). Ventricular tachycardia(VT) can occur in left and right coronary spasm. However, high degree AVB (atrioventricular block) mainly occurs in right coronary artery spasm.