大动脉转位合并房室传导阻滞患者的临床特征分析  

Clinical Characteristics of Patients With Transposition of Great Arteries Complicating Atrioventricular Block

作　　者：张硕[1] 李晓飞[1] 王钊[1] 宁小晖[1] 樊晓寒[1] ZHANG Shuo;LI Xiaofei;WANG Zhao;NING Xiaohui;FAN Xiaohan(State Key Laboratory of Cardiovascular Disease,Arrhythmia Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心律失常中心心血管疾病国家重点实验室,北京市100037

出　　处：《中国循环杂志》2022年第5期477-481,共5页Chinese Circulation Journal

摘　　要：目的:回顾性分析大动脉转位患者合并房室传导阻滞(AVB)的类型、特征及其他心律失常合并情况。方法:收集2003年1月至2020年1月我院45例合并AVB的大动脉转位患者(男性26例,女性19例)的临床资料,分析大动脉转位类型、超声Van Praagh分型、外科术前/术后发生AVB情况,其他心律失常的分布、治疗及随访情况。结果:45例患者平均入院年龄(30.6±18.7)岁,发现AVB时的年龄为(26.3±17.9)岁。发生AVB的大动脉转位患者以矫正型大动脉转位为主,占75.6%(34例),24.4%(11例)为右位心;超声Van Praagh分型多为SLL型占75.6%(34例),13.3%(6例)合并窦性心动过缓,11.1%(5例)合并房性心动过速,合并心房颤动、心房扑动和非持续性室性心动过速(NSVT)者均占6.7%(各3例),2.2%(1例)合并持续性室性心动过速/心室颤动。外科术前/术后出现AVB者为24/21例。35例植入起搏器患者中随访30例,平均随访时间(5.8±6.5)年,死亡7例,其中6例(6/30,20.0%)患者因心力衰竭加重死亡,1例患者在起搏器导线断裂后猝死。10例未植入起搏器患者中随访9例,患者平均随访时间(9.7±6.6)年。1例三度AVB患者拒绝植入起搏器,出院6年后猝死,3例三度AVB和3例一度AVB的患者无变化,2例二度AVB的患者进展为高度或三度AVB。结论:发生AVB的大动脉转位患者以矫正型大动脉转位为主,少数为右位心,可合并多种心律失常。外科术前、术后出现AVB的患者大致各占一半,起搏器治疗可预防猝死,但心力衰竭死亡率达20.0%。Objectives:To explore the clinical characteristics of patients with transposition of great arteries complicating atrioventricular block(AVB)as well as other arrhythmias.Methods:This retrospective study included 45 patients(26 males,19 females),who were treated in our hospital from January 2003 to January 2020 with diagnosis of transposition of the great arteries and AVB.The clinical data including classification of transposition of the great arteries,the ultrasonographic diagnosis,the preference of AVB,timing of AVB(before surgery or post surgery),and the preferences of other arrhythmias,therapy strategies and prognosis were analyzed.Results:The average age of included patients was(30.6±18.7)years,while AVB was found at mean of(26.3±17.9)years.The proportion of corrected transposition of the great arteries,which was the main type of transposition of great arteries complicated with AVB,was 75.6%(n=34).The proportion of Dextrocardia was 24.4%(n=11).The main type of Van Praagh was SLL,the proportion of which was 75.6%(n=34).Combined arrhythmias included sinus bradycardia(13.3%,n=6),atrial tachycardia(11.1%,n=5),atrial fibrillation,atrial flutter,non-persistent ventricular tachycardia(6.7%,n=3 each),persistent ventricular tachycardia/ventricular fibrillation(2.2%,n=1).AVB occurred after surgical treatment in 21 patients and before surgery in 24 cases.35 patients underwent pacemaker implantation,and follow-up data were available in 30 patients.During the mean follow-up of(5.8±6.5)years,7 cases died,6(6/30,20.0%)due to heart failure and 1 due to broken pacemaker lead.In 9 patients without device implantation,the mean follow-up duration was(9.7±6.6)years.Sudden cardiac death occurred in 1 case withⅢ°AVB 6 years after discharging.Progression was not observed in 3 cases withⅠ°AVB and 3 cases withⅢ°AVB.AVB was progressed fromⅡ°AVB to high orⅢ°AVB in 2 cases.Conclusions:AVB is common in patients with transposition of the great arteries and levocardia.AVB could be found before or after surgery.Pacemaker is

关 键 词：大动脉转位 房室传导阻滞 起搏器植入 特征性分析 

分 类 号：R541.4[医药卫生—心血管疾病]