Brembilla-Perrot B, Beurrier D, Houriez P, Claudon O, Wertheimer J
Cardiology, CHU of Brabois, Vandoeuvre, France.
Am J Cardiol. 2001 Jul 15;88(2):134-8. doi: 10.1016/s0002-9149(01)01607-1.
The objectives of this study were to: (1) define the incidence of presyncope and/or syncope in patients with paroxysmal junctional tachycardias, (2) determine their causes, and (3) determine the outcome of symptoms. Syncope is a frequent problem and is often caused by paroxysmal tachycardia. The mechanism of hemodynamic instability is unknown. The population study consisted of 281 patients, consecutively recruited because they had paroxysmal tachycardia and a sinus rhythm on a normal electrocardiogram. Fifty-two patients (group I) had presyncope and/or syncope associated with tachycardia. The remaining patients (group II) had no loss of consciousness. Transesophageal programmed atrial stimulation used 1 and 2 atrial extrastimuli, delivered in a control state, and if necessary, after infusion of 20 to 30 microg of isoproterenol. Arterial blood pressure was monitored. Vagal maneuvers and echocardiogram were performed in all patients. Paroxysmal tachycardia was induced in 51 group I patients and 227 group II patients. Comparisons of groups I and II revealed that age (50 +/- 21 vs 49 +/- 17 years), presence of heart disease (10% vs 10%), mechanism of tachycardia with a predominance of atrioventricular nodal reentrant tachycardia (70.5% vs 76%), and rate of tachycardia (196 +/- 42 vs 189 +/- 37 beats/min) did not differ between the groups. However, there were differences in both groups with regard to significantly higher incidences of positive vasovagal maneuvers (35% vs 4%, p <0.01), isoproterenol infusion required to induce tachycardia (55% vs 17%, p <0.001), and vasovagal reaction at the end of tachycardia (41% vs 4%, p <0.05). Thirty-seven group I patients underwent radiofrequency ablation of the reentrant circuit, which suppressed presyncope and/or syncope in 36 of the 37 patients. Thus, presyncope and/or syncope frequently complicated the history of patients with paroxysmal junctional tachycardia (18.5%). Several mechanisms are implicated, but vasovagal reaction was the most frequent cause. Treatment of the tachycardia typically suppressed presyncope and/or syncope.
（1）确定阵发性交界性心动过速患者中先兆晕厥和/或晕厥的发生率，（2）确定其病因，以及（3）确定症状的转归。晕厥是一个常见问题，常由阵发性心动过速引起。血流动力学不稳定的机制尚不清楚。这项人群研究包括281例患者，他们因阵发性心动过速且心电图显示窦性心律而被连续招募。52例患者（I组）有与心动过速相关的先兆晕厥和/或晕厥。其余患者（II组）没有意识丧失。经食管程控心房刺激在对照状态下使用1次和2次心房额外刺激，如果必要，在输注20至30微克异丙肾上腺素后进行。监测动脉血压。对所有患者进行了迷走神经手法操作和超声心动图检查。I组51例患者和II组227例患者诱发了阵发性心动过速。I组和II组的比较显示，两组在年龄（50±21岁对49±17岁）、心脏病的存在情况（10%对10%）、以房室结折返性心动过速为主的心动过速机制（70.5%对76%）以及心动过速的速率（196±42次/分钟对189±37次/分钟）方面没有差异。然而，两组在以下方面存在差异：阳性迷走神经手法操作的发生率显著更高（35%对4%，p<0.01）、诱发心动过速所需的异丙肾上腺素输注（55%对17%，p<0.001）以及心动过速末期的迷走神经反应（41%对4%，p<0.05）。37例I组患者接受了折返环路的射频消融，其中36例患者的先兆晕厥和/或晕厥得到了抑制。因此，先兆晕厥和/或晕厥经常使阵发性交界性心动过速患者的病史复杂化（18.5%）。涉及多种机制，但迷走神经反应是最常见的原因。心动过速的治疗通常可抑制先兆晕厥和/或晕厥。
