130例室性心动过速导致晕厥的住院患者诊治分析

Analysis of diagnosis and treatment of inpatients presenting with syncope due to ventricular tachycardia

目的分析室性心动过速(室速)导致晕厥的住院患者的临床特征及诊治现况。方法连续入选2014年9月至2019年6月中国医学科学院阜外医院心律失常中心二病区收治的552例晕厥患者,采集患者临床资料,排查晕厥病因。552例晕厥患者在住院期间由3位心内科(含电生理专业)医师制定诊疗计划。分析出院诊断为室速导致晕厥患者的临床特点以及诊治现况。结果经病史采集、体格检查、实验室检查,确诊为室速导致晕厥者130例(23.6%,130/552),其中男65例(50.0%,65/130),年龄(47.9±19.9)岁。伴有器质性心脏病70例(53.8%,70/130),离子通道疾病11例(8.5%,11/130),特发性室速49例(37.7%,49/130)。院前接受电复律32例(24.6%,32/130),包括已经植入心律转复除颤器(ICD)正确识别室速并放电治疗15例。68例具备ICD适应证的患者中10例(14.7%,10/68)拒绝植入,其中2例接受了导管消融治疗,8例仅药物治疗。已经植入的ICD正确识别治疗15例仍出现晕厥的室速患者,均系植入术后首次发作室速,给予调整ICD参数及调整药物治疗。共39例(30.0%,39/130)患者接受了导管消融治疗室速(占适应证的75.0%);较同期入院的晕厥病因为缓慢性心律失常及反射性晕厥者,室速导致晕厥的患者更年轻[3组依次为(64.5±15.3)岁、(52.8±15.8)岁、(47.9±19.9)岁,P<0.001],更常见器质性心脏病[3组依次为52例(23.6%)、13例(18.1%)、70例(53.8%),P<0.001],且左心室射血分数(LVEF)更低(61.5%±9.5%、65.2%±4.4%、55.9%±14.1%,P<0.001);院前曾电复律治疗室速的患者较无电复律史患者LVEF低(47.6%±11.9%、56.7%±14.0%,P=0.038)。结论本研究显示室速所致晕厥患者较缓慢性心律失常或反射性晕厥患者平均年龄小,其中合并器质性心脏病者占比较后者两组高,且LVEF更低。室速患者虽然发生了晕厥,拒绝ICD的比率仍较高,依从性有待提升。

Objective To analyze the clinical features,diagnosis and treatment of hospitalized patients with syncope due to ventricular tachycardia(VT).Methots A total of 552 patients with syncope were enrolled from September 2014 to June 2019 in ward 2nd of Arrhythmia Center of Beijing Fuwai Hospital.Demographics,medical histories,physical examination and laboratory tests were collected to investigate possible etiologies of syncope.Five hundred and fifty-two patients with syncope were evaluated by more than 3 cardiologists(including electrophysiologists)during hospitalization.Clinical characteristics,diagnosis and treatment of patients with syncope caused by VT were analyzed.Results The medical records including medical history,physical examination,and laboratory examination were collected.One hundred and thirty cases(23.6%,130/552)were diagnosed as VT,including male 65(50.0%,65/130),with an average age of(47.9±19.9)years.Seventy patients had structural heart diseases(53.8%,70/130),49 patients had idiopathic VT(37.7%,49/130),and 11 patients had ion channel disease(8.5%,11/130).Thirty-two patients(24.6%,32/130)received electrical cardioversion before the admission.In terms of treatment,58 patients who were implanted with implantable cardioverter defibrillation(ICD)as recommended.Ten patients(14.7%,10/68)refused ICD implantation,2 of whom underwent catheter ablation and 8 patients only received medication.Totally,39 patients(30.0%,39/130)were succeeded in catheter ablation of VT(75.0%of the indications).Compared with patients with bradycardia and reflex syncope admitted to the hospital at the same period,patients with VT were more younger[(64.5±15.3)years old,(52.8±15.8)years old,(47.9±19.9)years old,P<0.001],more likely to have structural heart diseases[52(23.6%),13(18.1%),70(53.8%),P<0.001)],and had a lower ejection fraction(61.5%±9.5%,65.2%±4.4%,55.9%±14.1%,P<0.001).In patients with VT,the ejection fraction of high-risk patients who underwent electrical cardioversion was also significantly lower than those who didn’t(47.6%±11.9%,56.7%±14.0%,P=0.038).Conclusion This study showed that patients with syncope caused by VT had a lower mean age than patients with slow arrhythmia or reflex syncope,and had a higher proportion of structural heart disease and worse cardiac function.The rejection rate of ICD is still high and needs to be improved.