预激综合征合并快慢综合征的临床分析

Preexcitation syndrome with tachycardia-bradycardia syndrome:Clinical analysis

目的 通过对 12例预激综合征合并室上性心动过速患者临床及电生理资料的分析 ,提出室上性心动过速发作结束时伴发的晕厥可能是窦房结功能一过性受抑的结果 ,探讨和证实这一发生机制设想的合理性。方法 12例预激综合征合并室上性心动过速患者 ,男 8例 ,女 4例 ,平均年龄 32 5岁 (19～ 4 9岁 )。均因室上性心动过速伴晕厥住院。经各种电生理检查评价窦房结功能 ,冠脉造影排除冠脉的异常 ,并进行射频消融术和 (或 )抗心动过速起搏器治疗。随访 2～ 5年。结果 12例患者均符合下列条件 :预激综合征伴发室上性心动过速结束时有晕厥发生 ,年龄多属青年、中年 ,经各种电生理检查提示窦房结功能正常。冠脉造影证实冠状动脉正常 ,室上性心动过速终止时心电图均证实为较长时间的窦性停搏。 4例经植入抗心动过速起搏治疗 ,3例经射频消融术及抗心动过速起搏器治疗 ,5例经射频消融术治疗 ,经 2～ 5年的随访 ,全组 12例患者无一例再发生室上性心动过速及晕厥。结论 预激综合征合并室上性心动过速伴发的晕厥均由功能性病态窦房结功能障碍机制引起 ,尽管因果关系明确 ,但与多数预激综合征患者的临床经过不一致的原因尚不清楚 ,有待进一步探讨。此外 ,这些符合快慢综合征患者晕厥治疗和预防的关键是根治室上性心动?

Objective To investigate the association between syncope and transient suppression of sinoatrial node in patients with preexcitation syndrome and paroxysmal supraventricular tachycardia (PSVT).Methods Twelve patients (male 8,female 4;age range:19-49 years) were enrolled due to WPW(Wolff-Parkinson-White) syndrome and syncope when the tachycardia terminated.The function of sinoatrial node was evaluated with clinical electrophysiologic study,and then radiofrequency catheter ablation (RFCA) or antitachycardia pacemaker were optimized for the patients with a follow-up of 2 to 5 years.Results Electrocardiographic features of the 12 patients were: ventricular preexcitation (type A in 7 and type B in 5) and long pause when tachycardias ended up.Electrophysiologic study revealed the function of sinoatrial node was normal.Four patients received antitachycardia pacing therapy,5 underwent RFCA,and 3 received both.The 2 to 5 years follow-up found no relapse of PSVT associated syncope.Conclusion Transient suppression of sinoatrial node might explain the mechanism of syncope with preexcitation and PSVT.However,the reason why such a small group of patients differ from the majority of preexcited cases in clinical course remains to be unsettled.The first choice of prevention and treatment for these patients should be eliminating PSVT.Conventional pacemaker implantation for preventing syncope seems to be unnecessary.