Brembilla-Perrot B, Claudon O, Beurrier D, Houriez P, Vançon A C, Suty-Selton C, Nippert M
CHU Brabois, rue du Morvan, 54500 Vandoeuvre-les-Nancy.
Arch Mal Coeur Vaiss. 2002 Oct;95(10):883-9.
The aim of this study was to determine whether ambulatory oesophageal electrophysiological recordings are valuable in identifying the cause of syncope in patients with a normal ECG and without cardiac disease. One hundred and forty-five patients aged 16 to 88 years of age, without cardiac disease, and with a normal ECG without a documented arrhythmia, were examined for unexplained syncope: 55 patients complained of palpitations at the time of syncope. The electrophysiological study was carried out in the clinic with oesophageal recordings using a classical protocol: Wenckebach point and sinus node recovery time were determined; programmed atrial stimulation was used with delivery of 1 and 2 extra-stimuli on the basal rhythm and with 20/30 micrograms infusion of isoprenaline; blood pressure was monitored. The study was negative in 41 patients (28%). Sinus node dysfunction was observed in 9 patients (6%). A vaso-vagal reaction reproducing the symptoms was induced by isoprenaline in 21 patients (14.5%); a conduction defect was revealed in 2 cases (1%). Atrial fibrillation or tachycardia > 1 minute was induced in 22 patients (15%). Paroxysmal junctional tachycardia was induced in 50 patients (35%). Patients with a negative study were younger than those with sinus node dysfunction or atrial fibrillation (44 +/- 21, 71 +/- 9 and 63 +/- 14 years respectively). Treatment was guided by these results: cardiac pacing, antiarrhythmic therapy or radiofrequency ablation of the reentrant pathway were indicated and suppressed syncope in all but two patients. The authors conclude that electrophysiological studies in the out-patient clinic with oesophageal recordings is a safe, rapid and economic method of detecting arrhythmias (sinus node dysfunction or supraventricular tachycardia) in 60% of patients with syncope, especially if they have symptoms of palpitations.
本研究的目的是确定动态食管电生理记录对于识别心电图正常且无心脏病患者晕厥原因是否有价值。145例年龄在16至88岁之间、无心脏病且心电图正常且无记录到心律失常的患者因不明原因晕厥接受检查：55例患者在晕厥时伴有心悸。在门诊采用经典方案进行食管记录的电生理研究：测定文氏点和窦房结恢复时间；在基础心律上给予1次和2次额外刺激并静脉输注20/30微克异丙肾上腺素进行程控心房刺激；监测血压。41例患者（28%）研究结果为阴性。9例患者（6%）观察到窦房结功能障碍。21例患者（14.5%）异丙肾上腺素诱发了重现症状的血管迷走反应；2例患者（1%）发现传导缺陷。22例患者（15%）诱发了房颤或心动过速>1分钟。50例患者（35%）诱发了阵发性交界性心动过速。研究结果为阴性的患者比窦房结功能障碍或房颤患者年轻（分别为44±21岁、71±9岁和63±14岁）。根据这些结果指导治疗：除2例患者外，所有患者均接受心脏起搏、抗心律失常治疗或折返径路的射频消融治疗，晕厥得到控制。作者得出结论，门诊食管记录的电生理研究是一种安全、快速且经济的方法，可在60%的晕厥患者中检测到心律失常（窦房结功能障碍或室上性心动过速），尤其是那些有心悸症状的患者。
