Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Am J Cardiol. 2021 Jun 1;148:124-129. doi: 10.1016/j.amjcard.2021.02.023. Epub 2021 Mar 3.
The ECG findings during sudden collapse (syncope or sudden death) in severe aortic stenosis (AS) are not well defined. We conducted a comprehensive review of the literature for ECG data during sudden collapse in patients with AS and provided a case report of our own. There were 37 published cases of syncope or sudden death in patients with severe AS which were documented by ECG. Brady- or ventricular arrhythmias were documented in 34 cases (92%). Bradyarrhythmia (n = 24; 71%) was more common at the time of collapse than ventricular tachyarrhythmia (n = 10; 29%). There was slowing of the sinus rate before bradyarrhythmia in the vast majority of patients with bradyarrhythmia but not in those presenting with ventricular tachyarrhythmia (75% vs 0%; p <0.001). ECG evidence of ischemia (ST-segment depression or elevation) was present in most patients with bradyarrhythmia but not in those with ventricular tachyarrhythmia (75% vs 0%; p = 0.011). In conclusion, our findings suggest that left ventricular baroreceptor activation plays a dominant role in the pathophysiology of sudden collapse in patients with severe AS and suggest that ischemia may play a role as well.
在严重主动脉瓣狭窄（AS）患者突然晕厥（晕厥或猝死）期间的心电图发现尚未明确。我们对 AS 患者突然晕厥期间的心电图数据进行了全面的文献回顾，并提供了一个我们自己的病例报告。有 37 例晕厥或猝死的严重 AS 患者的心电图记录。记录到 34 例（92%）缓或室性心律失常。晕厥时缓性心律失常（n=24；71%）比室性心动过速（n=10；29%）更常见。在大多数缓性心律失常患者中，缓性心律失常前窦性心率减慢，但在出现室性心动过速的患者中没有（75%比 0%；p<0.001）。大多数缓性心律失常患者的心电图有缺血证据（ST 段压低或抬高），但室性心动过速患者没有（75%比 0%；p=0.011）。总之，我们的发现表明，左心室压力感受器激活在严重 AS 患者突然晕厥的病理生理学中起主导作用，并表明缺血可能也起作用。
