Kramarz Elżbieta, Rudnicka Lidia, Samochocki Zbigniew
Internal Medicine and Cardiology Department, Military Institute of Medicine, Warsaw, Poland.
Department of Dermatology, Medical University of Warsaw, Warsaw, Poland.
Postepy Dermatol Alergol. 2021 Apr;38(2):269-273. doi: 10.5114/ada.2021.106203. Epub 2021 May 22.
It has been claimed that patients with systemic sclerosis (SSc) have an increased risk of developing cardiac arrhythmias and atrioventricular conduction disorders, but it is unknown whether SSc may be a cause of sinoatrial conduction abnormalities.
To establish the incidence of sinoatrial conduction abnormalities in patients with SSc and verify the relationship of these disorders with various clinical descriptors of SSc.
Forty women with systemic sclerosis of varying duration and severity underwent 24-hour ambulatory ECG monitoring. The occurrence of type I second-degree sinoatrial block (SA-block) and calculation of sinoatrial conduction time (SACT) were evaluated to establish the incidence of sinoatrial conduction abnormalities. The measurements of SACT were obtained using spontaneous atrial premature beats. The effect of various clinical descriptors on sinoatrial conduction abnormalities was assessed.
The mean ± SD SACT for the 40 patients was 150 ±15 ms. Prolonged (> 150 ms) SACT was found in 20 patients. In 14 (35%) patients SA-block occurred during ambulatory ECG monitoring. The discriminant analysis identified the severity of SSc cutaneous manifestation as an independent marker for developing SA-block ( < 0.005) and SACT prolongation ( < 0.0002).
Patients with SSc are at an increased risk of developing type I second-degree sinoatrial block and prolonged sinoatrial conduction time. The occurrence of these abnormalities is related to the severity of skin involvement. Therefore, cardiological diagnosis using 24-hour ambulatory ECG in this group of patients should be focused also on this type of disorders. Prospective, controlled studies are needed to assess their prognostic role.
据称，系统性硬化症（SSc）患者发生心律失常和房室传导障碍的风险增加，但SSc是否可能是窦房传导异常的原因尚不清楚。
确定SSc患者窦房传导异常的发生率，并验证这些障碍与SSc各种临床特征的关系。
40名病程和严重程度各异的系统性硬化症女性患者接受了24小时动态心电图监测。评估I型二度窦房阻滞（SA阻滞）的发生情况并计算窦房传导时间（SACT），以确定窦房传导异常的发生率。使用自发性房性早搏获得SACT的测量值。评估各种临床特征对窦房传导异常的影响。
40例患者的平均±标准差SACT为150±15毫秒。20例患者发现SACT延长（>150毫秒）。在14例（35%）患者的动态心电图监测期间发生了SA阻滞。判别分析确定SSc皮肤表现的严重程度是发生SA阻滞（<0.005）和SACT延长（<0.0002）的独立标志物。
SSc患者发生I型二度窦房阻滞和窦房传导时间延长的风险增加。这些异常的发生与皮肤受累的严重程度有关。因此，对这组患者使用24小时动态心电图进行心脏诊断时也应关注此类障碍。需要进行前瞻性对照研究以评估它们的预后作用。
