Medvedowsky J L, Barnay C
Ann Cardiol Angeiol (Paris). 1984 Jan;33(1):19-25.
Holter electrocardiographic monitoring and endocavitary electrophysiological investigations are often necessary in order to confirm the diagnosis of sinus dysfunction which may be suggested by the patient's symptoms and/or standard E.C.G. signs. A critical evaluation of these methods can be made on the basis of the experience gained in the course of recent studies. Provided sufficiently rigorous criteria are selected, the Holter monitor has an excellent specificity, about 90%, and a sensitivity of more than 70%. The value of the sinus refractory period reflects both sinus automatism and sino-atrial conduction; it is a sensitive criterion of sinus dysfunction. In contrast, the period of sino-atrial conduction has a much more limited sensitivity. However, analysis of the various parameters which reflect the response of the sino-atrial node to premature atrial stimulation provides important information. The authors also stress the value of the pharmacological tests used to sensitize the manoeuvres of atrial stimulation or to test the effects of the autonomic nervous system on sinus function. Autonomic blocking with a combination of atropine and propranolol can reveal certain disorders which can be masked by sympathetic activity and it can also determine the intrinsic or extrinsic nature of the sinus dysfunction. Thus electrophysiological investigations appear to be often essential in order to confirm a suspected diagnosis and in order to determine the severity and the nature of the sinus dysfunction.
为了确诊可能由患者症状和/或标准心电图体征提示的窦性功能障碍，动态心电图监测和心腔内电生理检查往往是必要的。根据近期研究中获得的经验，可以对这些方法进行批判性评估。如果选择足够严格的标准，动态心电图监测具有出色的特异性，约为90%，敏感性超过70%。窦房结不应期的值反映了窦房结自律性和窦房传导；它是窦性功能障碍的一个敏感标准。相比之下，窦房传导时间的敏感性则更为有限。然而，分析反映窦房结对房性早搏刺激反应的各种参数可提供重要信息。作者还强调了用于增强房性刺激操作敏感性或测试自主神经系统对窦房结功能影响的药理学试验的价值。阿托品和普萘洛尔联合进行自主神经阻滞可以揭示某些可能被交感神经活动掩盖的紊乱情况，还可以确定窦性功能障碍的内在或外在性质。因此，电生理检查对于确诊疑似诊断以及确定窦性功能障碍的严重程度和性质似乎往往至关重要。
