Rasmussen K, Thomsen P E, Bagger J P
Br Heart J. 1984 Jul;52(1):82-6. doi: 10.1136/hrt.52.1.82.
Intracardiac electrography and 24 hour ambulatory electrocardiographic monitoring were carried out in 20 patients with calcific aortic stenosis (mean pressure gradient 86 mm Hg) to investigate (a) the role of bradycardia and tachycardia in the pathogenesis of syncope in aortic stenosis, (b) the relation between haemodynamic data and electrophysiological abnormalities, and (c) whether valve replacement corrects electrophysiological abnormalities. Intracardiac electrograms showed impaired sinus node function in five patients and a prolonged HV interval (greater than or equal to 50 ms) in 11 but there was no difference in the findings of 13 patients with syncope and seven without. Ambulatory monitoring showed short pauses in three patients and brief episodes of tachycardia in four, but there was no difference in the findings of patients with and without syncope. The HV interval correlated inversely with the left ventricular ejection fraction, whereas no correlation was found between the HV interval and the pressure gradient. Nine patients were re-evaluated 15 months after aortic valve replacement. No change was found in sinus node function, but the HV interval had increased by 7.8 ms. It is concluded that in calcific aortic stenosis neither bradycardia nor tachycardia is shown to be a frequent cause of syncope, a prolonged HV interval is a frequent finding and further prolongation occurs after valve replacement, and contractility and conductivity appear to deteriorate in parallel.
对20例钙化性主动脉瓣狭窄患者（平均压力阶差86 mmHg）进行了心内电描记术和24小时动态心电图监测，以研究：（a）心动过缓和心动过速在主动脉瓣狭窄晕厥发病机制中的作用；（b）血流动力学数据与电生理异常之间的关系；（c）瓣膜置换是否能纠正电生理异常。心内电图显示，5例患者窦房结功能受损，11例患者HV间期延长（大于或等于50 ms），但13例有晕厥的患者与7例无晕厥的患者在检查结果上并无差异。动态监测显示，3例患者有短暂停搏，4例患者有短暂心动过速发作，但有晕厥和无晕厥患者的检查结果并无差异。HV间期与左心室射血分数呈负相关，而HV间期与压力阶差之间未发现相关性。9例患者在主动脉瓣置换术后15个月进行了重新评估。窦房结功能未发现变化，但HV间期增加了7.8 ms。结论是，在钙化性主动脉瓣狭窄中，心动过缓和心动过速均未被证明是晕厥的常见原因，HV间期延长是常见表现，瓣膜置换后会进一步延长，收缩性和传导性似乎会同时恶化。
