Twidale N, Heddle W F, Ayres B F, Tonkin A M
Department of Medicine, Flinders Medical Centre, Bedford Park, South Australia.
Aust N Z J Med. 1988 Dec;18(7):841-7. doi: 10.1111/j.1445-5994.1988.tb01641.x.
Electrophysiology study was performed in 93 patients with bifascicular block and unexplained syncope. Clinical evidence of organic heart disease was present in 33 (35%). Electrophysiological abnormalities were detected in 45 patients (48%). Of these, 36 had distal conduction disease, including 28 with an HV interval greater than 55 ms (mean 76.4 ms), and eight who developed infraHisian block following either intravenous procainamide (four) or atrial pacing (four). Sick sinus syndrome was evident in six patients and a further two had carotid sinus hypersensitivity. Sustained monomorphic ventricular tachycardia (VT) was induced in only three patients, two of whom also had prolonged HV interval. Among the 93 patients, 45 had therapy which was guided by positive findings at electrophysiology study (Group 1). Of these, 42 received permanent pacemakers, two were treated with combined permanent pacing and antiarrhythmic drug therapy, and one was treated with antiarrhythmic drug alone. In addition, eight patients without electrophysiologic abnormalities were treated empirically by pacing (Group 2). Finally, 40 patients without electrophysiologic abnormalities received no specific therapy (group 3). At a mean follow-up of 39 months (range two-125 months), recurrence of syncope had occurred in 4% of Group 1 patients, and 25% of Group 3 patients (p less than 0.05). No patient in Group 2 had had recurrence. Total mortality was 40%, including 47% of patients in Group 1, 25% of Group 2, and 35% of Group 3. Death was sudden in seven patients. We concluded that among patients with bifascicular block and syncope, therapy directed by findings at electrophysiology study was associated with symptomatic improvement, but mortality was not significantly influenced.(ABSTRACT TRUNCATED AT 250 WORDS)
对93例双分支阻滞伴不明原因晕厥的患者进行了电生理研究。33例（35%）有器质性心脏病的临床证据。45例（48%）检测到电生理异常。其中，36例有远端传导疾病，包括28例HV间期大于55毫秒（平均76.4毫秒），8例在静脉注射普鲁卡因胺（4例）或心房起搏（4例）后发生希氏束下阻滞。6例患者有明显的病态窦房结综合征，另外2例有颈动脉窦过敏。仅3例患者诱发出持续性单形性室性心动过速（VT），其中2例HV间期也延长。93例患者中，45例根据电生理研究的阳性结果接受了治疗（第1组）。其中，42例接受了永久性起搏器治疗，2例接受了永久性起搏和抗心律失常药物联合治疗，1例仅接受了抗心律失常药物治疗。此外，8例无电生理异常的患者经起搏进行了经验性治疗（第2组）。最后，40例无电生理异常的患者未接受特殊治疗（第3组）。平均随访39个月（范围2 - 125个月），第1组患者晕厥复发率为4%，第3组为25%（P < 0.05）。第2组无患者复发。总死亡率为40%，包括第1组的47%、第2组的25%和第3组的35%。7例患者猝死。我们得出结论，在双分支阻滞和晕厥患者中，根据电生理研究结果进行的治疗与症状改善相关，但对死亡率无显著影响。（摘要截断于250字）
