Guarnerio M, Disertori M, Vergara G, Bettini R, Inama G, Durante G, Furlanello F
G Ital Cardiol. 1984 Apr;14(4):234-44.
Congenital or idiopathic complete A-V block with no detectable heart disease may be complicated by near syncope, syncope or sudden death. The proposed predictive "risk factors" of these events have not proved sufficiently reliable so far. This study was undertaken in order to re-evaluate the correlation between symptoms and clinical and electrophysiological data with particular regard to the junctional recovery time in 10 patients (4 M; 6 F; mean age 24.4 +/- 9.6 at our first observation) with congenital or idiopathic complete A-V block. Patients were divided into 2 groups: group A (3 M; 3 F; mean age 27.8 +/- 10.6 at our first observation) with patients who complained of vertigo, near syncope or syncope before our study; group B (1 M; 3 F; mean age 19.2 +/- 4.1 at first observation) without cardiovascular symptoms before our study. In group A, Holter monitoring revealed periods of asystole longer than 3000 ms in 2, and ectopic ventricular arrhythmias mainly during effort in 2; ergometric stress test performed in 3 patients demonstrated ectopic ventricular arrhythmias in 2 (those who had ectopic ventricular arrhythmias at rest). In all patients the site of the block was suprahisian (demonstrated by electrophysiologic endocavitary study) with a normal H-V interval; mean junctional recovery time was 4.600 +/- 1.620 ms and corrected junctional recovery time was 3.088 +/- 1.500. Four patients had vertigo during the electrophysiologic endocavitary study. After Atropine 0.02 mg/Kg i.v. junctional recovery time and corrected junctional recovery time decreased respectively to 1052 +/- 238 and 166 +/- 38 ms (the measurement was made in 5 patients). In group B Holter monitoring revealed periods of asystole longer than 3000 ms in 1 case. All patients had ectopic ventricular arrhythmias, confirmed by the stress test. In this group too, the block was suprahisian (electrophysiologic endocavitary study) with normal H-V. Mean junctional recovery time was 5162 +/- 2408 ms; and corrected junctional recovery time 3687 +/- 2202. Two patients complained of dizziness during the electrophysiologic endocavitary study. After Atropine 0.02 mg/Kg i.v., junctional recovery time and corrected junctional recovery time decreased respectively to 1300 +/- 356 and 260 +/- 145 ms. Four group A and 1 group B patients received a permanent pacemaker and have remained asymptomatic since.(ABSTRACT TRUNCATED AT 400 WORDS)
先天性或特发性完全性房室传导阻滞且无明显心脏病者，可能会并发近似晕厥、晕厥或猝死。目前，这些事件的预测性“危险因素”尚未被证明足够可靠。本研究旨在重新评估10例先天性或特发性完全性房室传导阻滞患者（4例男性，6例女性；首次观察时平均年龄24.4±9.6岁）的症状与临床及电生理数据之间的相关性，尤其关注交界区恢复时间。患者分为两组：A组（3例男性，3例女性；首次观察时平均年龄27.8±10.6岁），研究前曾抱怨有眩晕、近似晕厥或晕厥；B组（1例男性，3例女性；首次观察时平均年龄19.2±4.1岁），研究前无心血管症状。在A组中，动态心电图监测显示2例患者有超过3000毫秒的心脏停搏期，2例患者主要在运动时出现室性异位心律失常；3例患者进行的运动负荷试验显示，其中2例（静息时有室性异位心律失常者）出现室性异位心律失常。所有患者的阻滞部位均在希氏束以上（经心腔内电生理研究证实），H-V间期正常；平均交界区恢复时间为4600±1620毫秒，校正后的交界区恢复时间为3088±1500毫秒。4例患者在心脏内电生理研究期间出现眩晕。静脉注射0.02毫克/千克阿托品后，交界区恢复时间和校正后的交界区恢复时间分别降至1052±238毫秒和166±38毫秒（在5例患者中进行测量）。在B组中，动态心电图监测显示1例患者有超过3000毫秒的心脏停搏期。所有患者均有室性异位心律失常，运动负荷试验证实。该组患者的阻滞同样在希氏束以上（心脏内电生理研究），H-V正常。平均交界区恢复时间为5162±2408毫秒；校正后的交界区恢复时间为3687±2202毫秒。2例患者在心脏内电生理研究期间抱怨头晕。静脉注射0.02毫克/千克阿托品后，交界区恢复时间和校正后的交界区恢复时间分别降至1300±356毫秒和260±145毫秒。A组4例患者和B组1例患者接受了永久性起搏器植入，此后一直无症状。（摘要截选至400字）
