心室停搏大于三秒的临床意义及起搏器应用的商榷  

Significance of ventricular pauses of 3 seconds or more and deliberation for the implantation of a permanent pacemaker

作　　者：钱秉源[1] 王龙华[1] 王建平[1] 

机构地区：[1]首都医科大学附属北京安贞医院

出　　处：《中华内科杂志》1998年第3期162-164,共3页Chinese Journal of Internal Medicine

摘　　要：目的探讨心室停搏大于３秒作为安置起搏器的指征是否合适。方法收集动态心电图（ＤＣＧ）检查中具有３秒以上ＲＲ间期的７９例病例，分析心室停搏的发生原因及起搏器应用情况对生存率的影响。结果６１８０例次Ｈｏｌｔｅｒ记录中心室停搏大于３秒７９例（８６例次１．４％）。心室停搏发生于心房纤颤（房颤）心房扑动（房扑）中２７例（３４．２％），房室传导阻滞３例（３．８％），房颤、房扑终止后１９例（２４．０％），室上性心动过速终止后９例（１１．４％），窦性停搏及Ⅱ度窦房传导阻滞２１例（２６．６％）。起搏组及非起搏组各死亡３例，两组３年生存率无差异。结论安置起搏器要结合心室停搏的原因及相关症状而定，对发生在房颤、房扑中的长时间心室停搏一般不必安置起搏器。Objective Ventricular pauses of 3 seconds or more is proposed by the clinicians in China and abroad as a definite indication for the implantation of a permanent pacemaker at present, but we think it is worth deliberating further. Methods 24 hour Holter recordings with the occurrence of ventricular pauses of 3 seconds or more were collected and analyzed together with the clinical history. Variables analyzed were clinical history, causes of the ventricular pauses, relationship of clinical symptoms with ventricular pauses and use of permanent pacing affecting the actuarial survival probabilities. Results 6 180 consecutive 24 hour Holter recordings were reviewed for the presence of ventricular pauses of at least 3 seconds. 79 patients (1.4% of total), 46 men and 33 women, were identified. Causes of the pauses were atrial fibrillation/ atrial flutter with slow ventricular response in 27 patients (34.2%), atrioventricular block in 3 patients (3.8%), pause after termination of atrial fibrillation/atrial flutter in 19 (24.0%), pause after termination of supraventricular tachycardia in 9 (11.4%), and sinus arrest/Ⅱ° sinus atrial block in 21 (26.6%). Thirteen of the 79 had dizziness during the pauses. 39 patients received permanent pacemakers. 40 patients were not paced. Three patients in the paced and 3 in the unpaced group died. 3 year actuarial survival probabilities did not differ significantly between the two groups. Conclusion Ventricular pauses of 3 seconds or longer are uncommon, these pauses usually do not cause symptoms. The prognosis is influenced by underlying heart disease especially the state of cardiac function. It is essential to consider the cause of the pause and the relevant symptoms before pacing. It is generally unnecessary to implant pacemakers when the pauses are caused by atrial fibrillation/atrial flutter with slow ventricular response. Pacing can be safely deferred in asymptomatic patients with sick sinus syndrome.

关 键 词：心律失常 心电图 起搏器 

分 类 号：R541.702[医药卫生—心血管疾病] R654.205[医药卫生—内科学]