阿托品试验联合24h动态心电图对窦性心动过缓患者猝死风险预测价值分析

Value of atropine test combining 24 h Holter in predicting risk of sudden death in patients with sinus bradyarrhythmia

目的研究阿托品试验联合24h动态心电图对预测窦性心动过缓患者猝死风险的效果分析。方法选取2011年2月~2015年3月于解放军第一医院接收的窦性心动过缓患者64例，所有患者均未安装心脏永久性起搏器，行24h动态心电图检查，延长1h给予阿托品静脉推注，记录患者最高心率变化，通过与24h动态心电图所示最慢时间段心率结果分析，评估窦性心动过缓患者猝死风险。结果所有受试的窦性心动过缓患者中，最低心率＜45次/min有21例，40～60次/min43例。在延长检查1h并接受阿托品激发试验后，以最大心率＞85次/min为阴性，共42例，＜85次/min为阳性，共22例，评估所有患者的猝死风险并进行分组，死亡13例，占20.3%，各组病死率有明显差异（P＜0.05）。结论阿托品试验联合24h动态心电图对窦性心动过缓患者猝死风险有明显预测价值，在1h激发试验过程中，如患者最大心率低于85次/min即视为猝死高风险患者，需格外警惕，可通过安装永久性起搏器以降低其猝死风险。

Objective To study the effect of atropine test combining 24 h ambulatory electrocardiographmonitoring (Holter) in predicting risk of sudden death in patients with sinus bradyarrhythmia. Methods The patients(n=64) were chosen from the Department of Heart and Kidney of Chinese PLA First Hospital from Feb. 2011 to Mar.2015, and all of them was implanted permanent pacemakers. The patients were given 24 h Holter for observing cardiacimpulse, and injected intravenously atropine in extended 1 h. The changes of maximum heart rate (HR) were recordedparticularly. The risk of sudden death was analyzed and reviewed through the outcomes of HR in the slowest periodshowed by 24 h Holter. Results Among all patients, there were 21 with HR<45/min in the minimum time, and 43with HR from 40 to 60/min in the minimum time. After atropine test during extended 1 h, there were 42 cases with themaximum HR>85/min (negative), and 22 with the maximum HR<85/min (positive), which were taken for reviewingthe risk of sudden death in all patients and grouping. There were totally 13 cases died (20.3%) and fatality rate hadsignificant difference among all groups (P<0.05). Conclusion Atropine provocative test combining 24 h Holter haspredictive value to the risk of sudden death in patients with sinus bradyarrhythmia. During 1 h atropine provocativetest, if patients’ HR is lower than 85/min, they will have higher risk of sudden death and they should be extra vigilant.Permanent pacemakers can decrease the risk of sudden death.