Manogue Michael, Hirsh David S, Lloyd Michael
Cardiac Electrophysiology Department, Emory University Hospital, Atlanta, Georgia.
Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia.
Heart Rhythm. 2017 Jun;14(6):920-927. doi: 10.1016/j.hrthm.2017.02.015. Epub 2017 Feb 12.
Spinal cord injury is a clinical syndrome encountered frequently in trauma centers and is accompanied by both acute and chronic heart rhythm abnormalities. The injury is characterized by sympathetic nervous system impairment with preservation of parasympathetic output via the vagus nerve. Severe bradycardia in the form of life-threatening sinus arrest or complete heart block may be observed in the acute recovery phase. Therapy for arrhythmias in the acute phase includes atropine, intravenous chronotropes, methylxanthines for the prevention of episodic bradycardia, and pacemaker implantation in severe cases. In the chronic recovery phase, autonomic dysreflexia in the form of paroxysmal hypertension is often induced by visceral organ distension or other stimuli and can be accompanied by bradycardia or tachycardia. The prognosis for survivors of spinal cord injury is expected to improve with further advances in surgical and medical care, and electrophysiologists will likely be called upon more frequently to help manage heart rhythm disorders in this setting.
脊髓损伤是创伤中心常见的临床综合征，伴有急性和慢性心律失常。该损伤的特征是交感神经系统受损，而迷走神经的副交感神经输出得以保留。在急性恢复期可能会观察到以危及生命的窦性停搏或完全性心脏传导阻滞形式出现的严重心动过缓。急性期心律失常的治疗包括阿托品、静脉用变时性药物、用于预防发作性心动过缓的甲基黄嘌呤，以及严重病例的起搏器植入。在慢性恢复期，阵发性高血压形式的自主神经反射异常常由内脏器官扩张或其他刺激诱发，可伴有心动过缓或心动过速。随着手术和医疗护理的进一步发展，脊髓损伤幸存者的预后有望改善，在此情况下，电生理学家可能会更频繁地被要求协助管理心律失常。
