Parameswaran R, Ohe T, Goldberg H
Br Heart J. 1976 Jan;38(1):93-6. doi: 10.1136/hrt.38.1.93.
The frequency, clinical course, and prognosis of sinus node dysfunction in 431 patients with acute myocardial infarction admitted to the coronary care unit were studied. Sinus node dysfunction occurred in 20 patients. In 13, the principal manifestation consisted of severe sinus bradycardia. In the remaining 7, periods of bradycardia alternating with episodes of supraventricular tachycardia were noted. Though several of the patients with sinus bradycardia required intravenous atropine or temporary pacing, normal sinus rhythm returned in virtually all during follow-up. The clinical course of patients with both bradycardia and tachycardia was less benign, during the acute phase and during follow-up; 5 of the 6 survivors required continued antiarrhythmic therapy or permanent pacing. The differences in the clinical course between these two groups of patients may reflect distinct underlying pathological changes. The findings in this study suggest that in contrast to sinus bradycardia, the occurrence of bradycardia-tachycardia syndrome during the acute phase of myocardial infarction may have important prognostic implications.
对收入冠心病监护病房的431例急性心肌梗死患者的窦房结功能障碍的发生率、临床病程及预后进行了研究。20例患者发生窦房结功能障碍。其中13例的主要表现为严重窦性心动过缓。其余7例可见心动过缓期与室上性心动过速发作交替出现。虽然部分窦性心动过缓患者需要静脉注射阿托品或临时起搏，但几乎所有患者在随访期间均恢复了正常窦性心律。心动过缓和心动过速患者在急性期及随访期间的临床病程均较差；6例幸存者中有5例需要持续抗心律失常治疗或永久起搏。这两组患者临床病程的差异可能反映了不同的潜在病理变化。本研究结果提示，与窦性心动过缓相反，心肌梗死急性期出现心动过缓-心动过速综合征可能具有重要的预后意义。
