植入起搏器患者合并心肌梗死心电图诊断的研究

ECG diagnosis of myocardial infarction in pacemaker-implanted patients

目的探讨植入起搏器患者合并心肌梗死心电图的诊断。方法选取2012年10月至2015年10月我院收治的植入心脏起搏器合并心肌梗死患者24例,由两位心电图诊断医师分析不同类型起搏器患者并发各分期心肌梗死的心电图。结果植入起搏器后,患者自身心室下传时,各分期心肌梗死患者的心电图特性不会被掩盖;当出现心室起搏时,心肌梗死分期的部分ST段T波变化以及Q波会被掩盖,部分难以辨别,其主要由植入起搏器类型、起搏工作模式、心肌梗死发生部位、置入电极部位以及心肌梗死分期等诸多因素决定。结论植入起搏器患者并发心肌梗死的心电图存在一定特殊性,临床诊断这类心电图时,需要和临床紧密结合,对患者的心电图变化情况予以动态监测,需要时应改变起搏方式,以提高心电图诊断的准确性。

Objective To study the ECG diagnosis of myocardial infarction in pacemakerimplanted patients. Methods In our study,24 pacemaker-implanted patients complicating myocardial infarction were selected from those treated in our hospital from October 2012 to October 2015. Two ECG diagnosis clinicians were arranged to analyze the ECGs of complicated myocardial infarction at different stages in patients implanted with different types of pacemakers. Results After implantation of pacemaker,the ECG characteristics of myocardial infarction at each stage will not be concealed when patients＇ own ventricular beats were conducted downward. In the appearance of ventricular pacing,parts of T wave changes and Q waves in ST segment at myocardial infarction stage were concealed while parts were difficult to be distinguished. It was mainly decided by a variety of factors including the types of implanted pacemakers,pacing mode,sites of myocardial infarction,locations of implanted electrode and the stage of myocardial infarction,etc. Conclusion There are some special characteristics in ECGs of pacemaker-implanted patients complicated with myocardial infarction. To improve the accuracy of ECG diagnosis,it is required to combine diagnosis with clinical circumstances closely,monitor ECG changes dynamically and switch pacing mode when necessary.