运动试验诱发恶性心律失常的无心肌梗死患者冠状动脉特点及预后  

Coronary artery characteristics and prognosis of patients without myocardial infarction with exercise test-induced malignant arrhythmia

作　　者：李玉凤[1] 吴永全 郝蓬[2] 王熙[1] 陈辉[1] 郭雅莲[1] 吕力军 果伟[1] 孙北 袁超[1] 周洋[1] 方冬平[4] LI Yufeng;WU Yongquan;HAO Peng;WANG Xi;CHEN Hui;GUO Yalian;LV Lijun;GUO Wei;SUN Bei;YUAN Chao;ZHOU Yang;FANG Dongping(Department of Electrocardiographic Room,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心电图室,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏起搏与CIED中心,100029 [3]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所病案统计科,100029 [4]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心律失常三区,100029

出　　处：《心肺血管病杂志》2024年第6期576-581,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:分析无心肌梗死患者平板运动试验(treadmill exercise test,TET)诱发恶性心律失常与冠状动脉狭窄的关系及救治效果。方法:回顾性选取1998年1月至2018年8月,在北京安贞医院行诊断性TET的63815例患者中,6例无心肌梗死患者出现恶性心律失常,并进一步行冠状动脉造影(coronary angiography,CAG)检查,分析TET心电图诱发恶性心律失常与冠状动脉狭窄的关系及救治效果,并做1年随访。结果:6例患者中,男性4例,女性2例,年龄39~51岁,均有胸痛和/或胸闷(憋)病史,4例为多形性室性心动过速(1例伴心室颤动),1例窦性停搏,1例单型性室性心动过速。2例晕厥,均行心肺复苏成功。6例患者均行冠状动脉造影检查,其中5例冠状动脉存在明显狭窄。第1例ST下移导联为ⅡⅢavF及V5-6,出现多形室性心动过速,冠状动脉狭窄及PCI干预血管为右冠状动脉(right coronary artery,RCA);第2例ST抬高导联为V1-3,出现室性心动过速心室颤动,冠状动脉狭窄及PCI干预血管为左前降支(left anterior descending,LAD);第3例ST抬高导联为ⅡⅢavF,出现窦性停搏,冠状动脉狭窄及PCI干预血管为RCA;第4例ST下移导联为V2-5,出现多形室性心动过速(尖端扭转),冠状动脉狭窄及PCI干预血管为钝缘支(obtuse marginal branch,OM);第5例ST下移导联为ⅡⅢavFV4-6,出现频发多形室性心动过速,冠状动脉狭窄及PCI干预血管为LAD;第6例室性心动过速持续22min,冠状动脉无有意义狭窄,行室性心动过速射频消融。结论:无心肌梗死患者TET诱发恶性心律失常是罕见的严重并发症,多数为冠状动脉严重狭窄所致心肌严重缺血表现,需要高度重视,及时救治。Objective:To analyze the relationship and therapeutic effect of treadmill exercise test(TET)induced malignant arrhythmia and coronary artery stenosis in patients without myocardial infarction.Methods:A retrospective selection was made from 63815 patients who underwent diagnostic TET at Beijing Anzhen Hospital affiliated with Capital Medical University from January 1998 to August 2018.Among them,6 patients without myocardial infarction developed malignant arrhythmias,and further coronary angiography(CAG)examination was performed to analyze the relationship between TET induced malignant arrhythmias and coronary artery stenosis,as well as the treatment effect.A one-year follow-up was conducted.Results:Among the 6 patients,there were 4 males and 2 females,aged 39-51 years old,all with a history of chest pain and/or chest tightness(suffocation).There were 4 cases of polymorphic ventricular tachycardia(1 with ventricular fibrillation),1 case of sinus arrest,and 1 case of monotypic ventricular tachycardia.Two cases of syncope were successfully treated with cardiopulmonary resuscitation.All 6 patients underwent coronary angiography,of which 5 had significant coronary artery stenosis.The first case of ST downshifting leads is II III avF and V5-6,presenting with polymorphic ventricular tachycardia,coronary artery stenosis,and PCI intervention vessel being the right coronary artery(RCA);The second ST elevation lead was V1-3,with ventricular tachycardia and ventricular fibrillation,coronary artery stenosis,and PCI intervention vessel being the left anterior descending(LAD);The third ST elevation lead was II III avF,with sinus arrest,coronary artery stenosis,and PCI intervention vessel being RCA;The fourth case of ST downshift lead was V2-5,with polymorphic ventricular tachycardia(tip torsion),coronary artery stenosis,and PCI intervention vessel as OM;The fifth case of ST downshift lead is II III avFV4-6,with frequent polymorphic ventricular tachycardia,coronary artery stenosis,and PCI intervention vessel being the LAD;The si

关 键 词：平板运动试验 心电图 恶性心律失常 冠状动脉狭窄 支架 

分 类 号：R54[医药卫生—心血管疾病]