Brembilla-Perrot B, Chometon F, Marçon O, Duhoux F, Bertrand J, Terrier de la Chaise A, Louis P, Claudon O, Selton O, Belhakem H, Khaldi E, Abbas M, Zhang N, Beurrier D
Service de cardiologie, CHU de Brabois, rue du Morvan, 54500 Vandoeuvre-les-Nancy, France.
Ann Cardiol Angeiol (Paris). 2009 Aug;58(4):215-9. doi: 10.1016/j.ancard.2009.03.002. Epub 2009 Apr 1.
The purpose of the study was to determine the possible mechanisms of presyncope in patients who have paroxysmal junctional tachycardias (PJT) and a normal surface ECG between tachycardias.
Among 419 patients consecutively recruited for PJT, aged from 10 to 88 years (47+/-19), 78 of them had presented at least one syncope; they had a normal ECG in sinus rhythm. Transesophageal programmed atrial stimulation was performed using one and two atrial extrastimuli delivered in control state and if necessary after infusion of 20-30 microg of isoproterenol; arterial blood pressure was monitored; vagal maneuvers and tilt test (n=25) were performed; echocardiogram was systematic.
Age, sex, method of induction, tachycardia mechanism and the mean heart rate in tachycardia were similar in patients with and without syncope. Syncope was related to a vagal reaction induced by the PJT in 31 patients, to a fast rate during PJT in 15 patients, to a sinus node dysfunction in six patients, to a coronary ischemia in five patients, to a tetany induced by PJT in three patients, to an advanced age in three patients, to multiple causes in three patients and remained unexplained in eight patients. Radiofrequency ablation of reentrant circuit, performed in 28 patients, suppressed syncope in 26 of them.
Presyncope or syncope occurred in 18% of patients who had a history of paroxysmal junctional tachycardia. Several mechanisms were implicated; the most frequent causes were coronary ischemia or sick sinus syndrome in old patients, vasovagal reaction or fast rate in tachycardia or tetany in patients of all ages.
本研究的目的是确定阵发性交界性心动过速（PJT）且心动过速间期体表心电图正常的患者发生先兆晕厥的可能机制。
在连续纳入的419例年龄为10至88岁（47±19岁）的PJT患者中，78例曾出现至少一次晕厥；他们窦性心律时心电图正常。在对照状态下使用1次和2次心房额外刺激进行经食管程控心房刺激，必要时在输注20 - 30微克异丙肾上腺素后进行；监测动脉血压；进行迷走神经手法操作和倾斜试验（n = 25）；常规进行超声心动图检查。
有晕厥和无晕厥的患者在年龄、性别、诱发方法、心动过速机制以及心动过速时的平均心率方面相似。31例患者的晕厥与PJT诱发的迷走神经反应有关，15例与PJT时的快速心率有关，6例与窦房结功能障碍有关，5例与冠状动脉缺血有关，3例与PJT诱发的手足搐搦有关，3例与高龄有关，3例与多种原因有关，8例原因不明。对28例患者进行折返环路的射频消融，其中26例晕厥得到抑制。
有阵发性交界性心动过速病史的患者中，18%发生了先兆晕厥或晕厥。涉及多种机制；最常见的原因是老年患者的冠状动脉缺血或病态窦房结综合征，各年龄段患者的血管迷走神经反应、心动过速时的快速心率或手足搐搦。
