Carnlöf Carina, Iwarzon Marie, Jensen-Urstad Mats, Gadler Fredrik, Insulander Per
a Karolinska Institute of Medicine, C1-82, Heart and Vascular Theme , Karolinska University Hospital , Stockholm , Sweden.
b Karolinska Institute of Medicine, Department of Neurobiology, Care Sciences and Society , Huddinge , Sweden.
Scand Cardiovasc J. 2017 Dec;51(6):299-307. doi: 10.1080/14017431.2017.1385837. Epub 2017 Oct 13.
Using a patient and gender perspective, this study evaluates the experiences and perspectives of referral for paroxysmal supraventricular tachycardia (PSVT), and symptoms, Health-Related Quality of Life (HRQOL) and functional impairment before and six months after ablation.
This prospective study includes 214 (109 women) patients with PSVT who completed questionnaires before and after ablation addressing referral patterns, duration of arrhythmia, socioeconomic status, symptoms, HRQOL, and functional impairment.
Women had a longer history of symptomatic arrhythmia before ablation compared to men (16.2 ± 14.6 vs. 9.9 ± 13.1 years, p = .001). From the patient's perspective, physicians more often incorrectly interpreted women's symptoms as anxiety, stress, panic attacks, or depression compared to men, delaying referral for ablation. More women than men stated they were not taken seriously when consulting for their tachycardia symptoms (17% vs.7%, p = .03). At baseline, there were minor differences between the sexes in HRQOL and functional impairment, but women had a higher symptom score on Symptoms Checklist Frequency (19 vs. 14, p < .001) and Severity Scale (12 vs. 16, p = .001). At six months, women were more symptomatic and their HRQOL improved less than in men. Both sexes reported improvement in recreation and pastime (p = .001).
Women with PSVT are referred for ablation later, and are more symptomatic before and after ablation than men. Symptoms due to PSVT are often incorrectly diagnosed as panic attacks, stress, anxiety, or depression, misdiagnoses that delay referral for ablation, especially for women.
本研究从患者及性别角度评估阵发性室上性心动过速（PSVT）转诊的经历与观点，以及消融术前和术后六个月的症状、健康相关生活质量（HRQOL）和功能损害情况。
这项前瞻性研究纳入了214例（109例女性）PSVT患者，他们在消融术前和术后完成了关于转诊模式、心律失常持续时间、社会经济状况、症状、HRQOL和功能损害的问卷调查。
与男性相比，女性在消融术前有症状性心律失常的病史更长（16.2±14.6年 vs. 9.9±13.1年，p = 0.001）。从患者角度来看，与男性相比，医生更常将女性的症状错误地解释为焦虑、压力、惊恐发作或抑郁，从而延迟了消融转诊。表示在因心动过速症状就诊时未被认真对待的女性比男性更多（17% vs. 7%，p = 0.03）。在基线时，两性在HRQOL和功能损害方面存在微小差异，但女性在症状清单频率（19 vs. 14，p < 0.001）和严重程度量表（12 vs. 16，p = 0.001）上的症状评分更高。在六个月时，女性症状更明显，其HRQOL改善程度低于男性。两性均报告在娱乐和消遣方面有所改善（p = 0.001）。
PSVT女性患者接受消融转诊的时间较晚，且在消融前后比男性症状更明显。PSVT引起的症状常被错误诊断为惊恐发作、压力、焦虑或抑郁，这些误诊会延迟消融转诊，尤其是对女性患者。
