Szatmáry L J, Solti F, Albared J L, Pisapia A
Department of Cardiovascular Surgery, Semmelweis University Medical School, Budapest, Hungary.
Cor Vasa. 1989;31(3):216-24.
Based on clinical and experimental experience, pacemaker dysfunction in sick sinus syndrome can be differentiated into intrinsic and extrinsic. Sinus node activity is characterized electrophysiologically by automaticity, recovery and sinoatrial conduction. The automaticity of the sinus pacemaker cell groups and sinus recovery can be differentiated properly under experimental conditions. Studies of the electrophysiological characteristics have shown the basic functional parameters to be normal in extrinsic-autonomic sinus dysfunction. Diagnosis is either based on clinical observation or on the data of Holter monitoring, the electrophysiological methods being inadequate for diagnosing this neurovegetative form of sick sinus syndrome. On the other hand, intrinsic sinus dysfunction can be diagnosed by electrophysiological tests. If completed by complex pharmacological studies, in this organic form of sick sinus syndrome, even the severity of the intrinsic injuries can be assessed quantitatively. The above division provides a basis for selection and evaluation of the differential diagnostic procedures, while information on the aetiopathology of sinus dysfunction and on the degree of the functional injuries of the electrophysiological structure of the heart provides an adequate basis for therapy.
根据临床和实验经验，病态窦房结综合征中的起搏器功能障碍可分为内在性和外在性。窦房结活动在电生理上的特征是自律性、恢复能力和窦房传导。在实验条件下，可以正确区分窦房结起搏细胞群的自律性和窦房结恢复能力。对电生理特征的研究表明，外在性自主神经窦房功能障碍的基本功能参数是正常的。诊断要么基于临床观察，要么基于动态心电图监测数据，电生理方法不足以诊断这种神经植物性形式的病态窦房结综合征。另一方面，内在性窦房功能障碍可通过电生理测试来诊断。如果通过复杂的药理学研究来完成，在这种器质性形式的病态窦房结综合征中，甚至可以定量评估内在损伤的严重程度。上述分类为鉴别诊断程序的选择和评估提供了依据，而关于窦房功能障碍的病因病理学以及心脏电生理结构功能损伤程度的信息为治疗提供了充分的依据。
