Borbola József, Földesi Csaba, Kardos Attila, Som Zoltán
Felnőtt Kardiológiai Osztály, Elektrofiziológiai és Pacemaker Terápiás Osztály, Gottsegen György Országos Kardiológiai Intézet Budapest, Haller u. 29., 1096.
Orv Hetil. 2019 Sep;160(37):1464-1470. doi: 10.1556/650.2019.31462.
The inadequate, inappropriate sinus-node tachycardia is not a rare clinical syndrome, defined as a non-paroxysmal, increased sinus-rate at rest, and/or inadequate response to physical and/or emotional stress, and palpitations. The aim of this study was to describe our experiences with the investigations of our inappropriate sinus-node tachycardia patients. In the last years, 104 patients (92 women, 12 men, mean age: 31 ± 10 years) were treated with this cardiac arrhythmia entity. All patients underwent 12 leads ECG, chest X-ray, echocardiography, Holter-monitoring and transtelephonic ECG observations. The quality of life score was estimated by using the European Heart Rhythm Association scale. Patients had no structural heart disease (physical examination ECG, chest X-ray, echocardiography were normal), the laboratory values (TSH, blood count) were within normal limits, but the resting heart rates were repeatedly high (102 ± 8/min). The results of Holter recording (expressed as minimal-maximal [average] heart rate/min) without drug therapy showed high heart rate values (59 ± 8, 160 ± 14 [94 ± 6]/min). The standard bicycle ergometry showed an average loading capacity of 124 ± 23 watt (heart rate: control: 99 ± 12/min, top: 167 ± 13/min) with early, inadequate sinus tachycardia. To disclose the episodes of paroxysmal supraventricular tachycardia, beside the Holter-monitoring transtelephonic ECG system was used. This diagnostic modality was very useful for the exclusion of paroxysmal supraventricular tachycardia episodes during the palpitation symptoms. Out of 104 patients, 4 patients (3.8%) showed familiar occurrence, another 16 patients (15.2%) had previous slow-pathway radiofrequency ablation due to atrioventricular nodal reentry tachycardia. Based on our clinical observations, it can be pointed out that inappropriate sinus-node tachycardia syndrome (1) occurs mainly in young women, mostly in students, inducing decreased quality of life scores (EHRA score: 2.3 ± 0.4); (2) the prevalence in our outpatient clinic was 0.7%; (3) the patient population is not homogeneous: familiar or postablation occurrence is possible in some patients; (4) transtelephonic ECG has been proved to be very useful to disclose episodes of paroxysmal supraventricular tachycardia in these patients. Orv Hetil. 2019; 160(37): 1464-1470.
不适当的、不恰当的窦房结性心动过速并非罕见的临床综合征，其定义为非阵发性、静息时窦性心率增加和/或对身体和/或情绪应激反应不足以及心悸。本研究的目的是描述我们对不适当窦房结性心动过速患者进行检查的经验。在过去几年中，104例患者（92例女性，12例男性，平均年龄：31±10岁）接受了这种心律失常疾病的治疗。所有患者均接受了12导联心电图、胸部X线、超声心动图、动态心电图监测和经电话心电图观察。使用欧洲心律协会量表评估生活质量评分。患者无结构性心脏病（体格检查、心电图、胸部X线、超声心动图均正常），实验室值（促甲状腺激素、血细胞计数）在正常范围内，但静息心率反复偏高（102±8次/分钟）。未进行药物治疗时动态心电图记录结果（以最小-最大[平均]心率/分钟表示）显示心率值较高（59±8，160±14[94±6]/分钟）。标准踏车运动试验显示平均负荷能力为124±23瓦（心率：对照组：99±12次/分钟，最高：167±13次/分钟），伴有早期、不适当的窦性心动过速。为了揭示阵发性室上性心动过速发作，除了动态心电图监测外，还使用了经电话心电图系统。这种诊断方式对于排除心悸症状发作时的阵发性室上性心动过速发作非常有用。在104例患者中，4例（3.8%）有家族性发病，另外16例（15.2%）既往因房室结折返性心动过速接受过慢径路射频消融术。根据我们的临床观察，可以指出，不适当窦房结性心动过速综合征（1）主要发生在年轻女性，大多为学生，导致生活质量评分降低（欧洲心律协会评分：2.3±0.4）；（2）在我们门诊的患病率为0.7%；（3）患者群体并非同质：部分患者可能有家族性发病或消融术后发病；（4）经电话心电图已被证明对揭示这些患者的阵发性室上性心动过速发作非常有用。《匈牙利医学周报》。2019年；160（37）：1464 - 1470。
