Paul T, Guccione P, Garson A
Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
Am J Cardiol. 1990 Feb 1;65(5):318-21. doi: 10.1016/0002-9149(90)90295-c.
Syncope in patients due to Wolff-Parkinson-White (WPW) syndrome may be related either to a rapid rate of supraventricular tachycardia or to rapid ventricular response over the accessory pathway during atrial fibrillation (AF). From 1982 to 1987, 74 patients less than or equal to 25 years old (mean age 12.6 years) with WPW syndrome on electrocardiogram underwent electrophysiologic study. Of the 74 patients, 14 (19%) had a history of syncope. During electrophysiologic study 9 of 14 patients with syncope had sustained (greater than 5 minutes or requiring termination due to hypotension) AF. Of the remaining 5 patients, 3 had inducible nonsustained AF and 2 had no AF. None of the 60 patients without syncope developed sustained AF; 34 had nonsustained and 26 had no AF. Occurrence of sustained AF had a sensitivity of 64% and specificity of 100% for history of syncope. All patients with syncope and AF (12) had a short RR interval between 2 consecutive preexcited QRS complexes during AF at less than or equal to 220 ms, in contrast to 9 of 34 patients without syncope (p less than 0.001, sensitivity 100%, specificity 74%). No patient with a short RR interval between 2 consecutive preexcited QRS complexes during AF of greater than 220 ms had a history of syncope. Thus, in these young patients with WPW syndrome, occurrence of AF with a rapid ventricular response during electrophysiologic study correlated well with a history of syncope and may be the cause of syncope in most patients. Electrophysiologic study may be helpful in identification of young patients with WPW at risk for syncope.
预激综合征（WPW）患者发生晕厥可能与室上性心动过速的快速心率有关，也可能与房颤（AF）时经旁路的快速心室反应有关。1982年至1987年，74例心电图显示WPW综合征且年龄小于或等于25岁（平均年龄12.6岁）的患者接受了电生理检查。在这74例患者中，14例（19%）有晕厥史。在电生理检查中，14例有晕厥史的患者中有9例发生了持续性（大于5分钟或因低血压需要终止）房颤。其余5例患者中，3例可诱发非持续性房颤，2例未发生房颤。60例无晕厥史的患者均未发生持续性房颤；34例有非持续性房颤，26例未发生房颤。持续性房颤的发生对晕厥史的敏感性为64%，特异性为100%。所有有晕厥和房颤的患者（12例）在房颤时连续两个预激QRS波群之间的RR间期较短，小于或等于220毫秒，相比之下，34例无晕厥患者中有9例（p<0.001，敏感性100%，特异性74%）。房颤时连续两个预激QRS波群之间RR间期大于220毫秒的患者均无晕厥史。因此，在这些年轻的WPW综合征患者中，电生理检查时出现快速心室反应的房颤与晕厥史密切相关，可能是大多数患者晕厥的原因。电生理检查可能有助于识别有晕厥风险的年轻WPW患者。
