Levy A M, Camm A J, Keane J F
Circulation. 1977 Feb;55(2):247-53. doi: 10.1161/01.cir.55.2.247.
Twenty patients with congenital complete heart block (CHB) were monitored with ECG tape recordings while awake and asleep. Episodes of marked ventricular slowing during sleep (R-R greater than 3000 msec., i.e. less than 20 beats/min) were noted in 35% (7/20). Most of these sudden R-R prolongations were 2:1 or 3:1 exit block of the junctional focus. Atrial and ventricular rate changes were mostly concordant in 2/3 but the remainder demonstrated fixed ventricular rates while atrial rates varied normally, suggesting a "sick" or "lazy" junctional focus. Other arrhythmias were found in 60% (12/20), including several types of rhythms in three patients. One child with previously unsuspected superimposed multiple arrhythmias later had a syncopal episode despite proven supra-Hisian block. The multiple patterns of atrial and ventricular rate changes found indicate complex feedback mechanisms, suggesting that congenital CHB is not a single entity. Since a significant number of patients demonstrated one or another of these unexpected and potentially hazardous findings, we recommend that congenital block patients be carefully studied, including Holter monitoring done on a regular basis.
对20例先天性完全性心脏传导阻滞（CHB）患者在清醒和睡眠状态下进行心电图磁带记录监测。35%（7/20）的患者在睡眠期间出现明显的心室减慢（R-R大于3000毫秒，即每分钟少于20次心跳）。这些突然的R-R延长大多为交界性起搏点的2:1或3:1传出阻滞。三分之二患者的心房和心室率变化大多一致，但其余患者表现为心室率固定，而心房率正常变化，提示交界性起搏点“病变”或“怠惰”。60%（12/20）的患者发现有其他心律失常，包括三名患者出现几种类型的节律。一名先前未被怀疑有叠加性多种心律失常的儿童，尽管已证实存在希氏束以上阻滞，但后来仍发生了一次晕厥发作。所发现的心房和心室率变化的多种模式表明存在复杂的反馈机制，提示先天性CHB并非单一实体。由于大量患者表现出这些意外且潜在危险的发现中的一种或另一种，我们建议对先天性心脏传导阻滞患者进行仔细研究，包括定期进行动态心电图监测。
