Benson D W, Spach M S, Edwards S B, Sterba R, Serwer G A, Armstrong B E, Anderson P A
Pediatr Cardiol. 1982;2(1):39-45. doi: 10.1007/BF02265615.
To evaluate subsidiary ventricular pacemaker function in 20 children with congenital or surgically induced complete heart block, we measured recovery times following overdrive ventricular pacing. Long-term ECG tape recordings were performed in eight of these children. Ages ranged from 1 month to 17 years. The resting R-R intervals ranged from 595 to 1,740 msec. The ventricles were paced at various cycle lengths of 400 to 1,000 msec with either transvenous electrode catheters or surgically implanted epicardial electrodes. His bundle recordings showed that the site of block did not allow separation of patients with symptoms from those without symptoms. Prolonged recovery times were present in patients with block above the His bundle recording site who had symptoms of syncope or dizziness, as well as in patients who had a wide QRS. However, some asymptomatic patient with heart block above the His bundle recording site also had long recovery times. None of the asymptomatic patients who had ECG tape recordings had paroxysmal tachycardia in more than 300 hours of recordings. However, one symptomatic patient with congenital heart block and a prolonged recovery time had brief episodes of paroxysmal ventricular tachycardia that produced no symptoms at the time of recording. The results suggest that the coexistence of prolonged recovery times and paroxysmal tachycardia may be predisposing factors to the development of symptoms in patients with complete heart block. We believe that further electrophysiologic investigation of this possibility is warranted in patients with heart block.
为评估20例先天性或手术所致完全性心脏传导阻滞患儿的心室辅助起搏器功能，我们测量了超速心室起搏后的恢复时间。其中8例患儿进行了长期心电图磁带记录。年龄范围为1个月至17岁。静息R-R间期为595至1740毫秒。采用经静脉电极导管或手术植入的心外膜电极，以400至1000毫秒的不同周期长度对心室进行起搏。希氏束记录显示，阻滞部位无法区分有症状和无症状的患者。希氏束记录部位上方存在阻滞且有晕厥或头晕症状的患者，以及QRS波增宽的患者，恢复时间延长。然而，一些希氏束记录部位上方有心脏传导阻滞的无症状患者恢复时间也较长。在超过300小时的记录中，进行了心电图磁带记录的无症状患者均未出现阵发性心动过速。然而，1例有先天性心脏传导阻滞且恢复时间延长的有症状患者出现了短暂的阵发性室性心动过速发作，记录时未产生症状。结果表明，恢复时间延长和阵发性心动过速并存可能是完全性心脏传导阻滞患者出现症状的易感因素。我们认为，对心脏传导阻滞患者进一步进行这种可能性的电生理研究是有必要的。
