Brugada综合征伴发的室上性心律失常  

The clinical observation on supraventricular arrhythmias in patients with Brugada syndrome

作　　者：刘冰[1] 张英川[1] 郭成军[1] 方冬平[1] 郭晋萍[1] 

机构地区：[1]首都医科大学附属安贞医院心内科,北京100029

出　　处：《中华心律失常学杂志》2007年第3期210-214,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的：报道Brugada综合征伴发的多种室上性心律失常。方法：对符合Brugada综合征诊断标准的46例患者行动态心电图检查，记录心律失常发作类型，部分行电生理检查与射频消融治疗。结果：男性39例，女性7例。21例有家族史，23例有晕厥史，其中3例经心肺复苏。46例中5例并发阵发性室上性心动过速（阵发性室上速，4例为显性预激综合征）；3例室上速与心房扑动（房扑）并存；2例室上速与室性心动过速（室速）并存；14例房性心动过速（房速）、房扑和心房颤动（房颤）；2例房速伴三度房室阻滞；1例房速与室速并存；11例多形室速；5例单形室速；1例室颤电风暴并三度房室阻滞；1例室速与三度房室阻滞并存；1例室速与三度房室阻滞、房颤并存。39例行射频消融治疗成功32例，4例并发三度房室阻滞者植入心脏永久起搏器，4例植入心律转复除颤器。结论：除室速、室颤外，Brugada综合征可发生房颤、房扑、室上速、三度房室阻滞等多种心律失常，且两种以上心律失常可以共存。Brugada综合征心脏钠通道基因变异引起细胞膜钠通道功能异常不仅存在于希氏一浦肯野系统和心室肌，亦可存在于心房肌及房室结，引发多种类型心律失常。Objective To report various types of supraventricular arrhythmias in patients with Brugada syndrome. Methods Forty-six patients with spontaneous Brugada-Type ECG and with ventricular and/or supraventricular tachyarrhythmia, excluded structural heart disease by echocardiography, undertaken 24 h-Hoher recording,electrophysiological study and ablation. Results There were 39 in male and 7 in famale [ mean age （37.44 ± 14. 52 ） years ]. Twenty-one patients had family history of tachycardia, twenty-three patients experienced episodes of syncope, three patients were resuscitated from cardiac arrest. One patient had ventricular fibrillation and third-degree atrioventricular block, eleven patients had polymorphic ventricular tachycardia and 5 patients had monomorphic ventricular tachycardia. Fourteen patients had atrial tachyarrhythmia,paroxysmal supraventricular tachycardia was found in 5 patients include 4 Wolff-Parkinson-White syndrome, two patients had ventricular tachycardia and third-degree atrioventricular block, one of them had atrial fibrillation, two patients had both supraventricular tachycardia and ventricular tachycardia, three patients had both atrial tachyarrhythmia and supraventricular tachycardia, two third-degree atrioventricular block patients had atrial flutter, one patient had both atrial tachyarrhythmia and ventricular tachycardia. Ablation was performed in 39 patients and succeed in 32, four patients were implanted with pacemakers, four patients had implantable cardioverter defibrillators. Conclusion In addition to ventricular tachycardia and ventricular fibrillation,patients with Brugada syndrome exhibit various supraventricular tachyarrhythmias and third-degree atrioventricular block. In patients with Bruga- da syndrome, the dysfunction of the cardiac ion channel, which related to mutation of cardiac sodium channel gene, is not limited in His-Purkinje system and ventricular myocardlum, but also in the atrium and atrioventricular node, which may serves as a cause of dispersion of repolarizatio

关 键 词：BRUGADA综合征 心律失常 传导异常 

分 类 号：R541[医药卫生—心血管疾病]