Karpawich P P, Gillette P C, Garson A, Hesslein P S, Porter C B, McNamara D G
Am J Cardiol. 1981 Dec;48(6):1098-102. doi: 10.1016/0002-9149(81)90326-x.
Because of initial Adams-Stokes attack in the patient with congenital complete atrioventricular (A-V) block may sometimes prove fatal, there is a need to be able to identify the patient at great risk of having such attacks. Twenty-four children with congenital complete A-V block were followed up for 1 to 19 years to determine the efficacy of current methods of predicting risk for Adams-Stokes syncope and the usefulness of pacemaker therapy in relieving symptoms. The heart rate at rest, configuration of surface electrocardiographic complexes, data obtained during intracardiac electrophysiologic study and response to graded treadmill exercise testing were compared in children with and without syncope. One or more Adams-Stokes episodes were experienced by eight children, one of whom died. Only a persistent heart rate at rest of 50 beats/min or less demonstrated any significant (probability [p] less than 0.01) correlation with the incidence of syncope. Intracardiac electrophysiologic study was of little benefit because of site of block did not correlate with syncope. Although the increase in heart rate during treadmill exercise testing showed no correlation with prevalence of syncope or location of block, exercise-induced ventricular ectopic beats may have predictive value in older children and young adults. Ventricular pacemakers were implanted in 10 children. Each child was asymptomatic over a 1 to 10 year follow-up period. Because extreme bradycardia may contribute to the prevalence of Adams- Stokes attacks in children with congenital complete A-V block, careful evaluation of heart rate at rest may be an effective means of differentiating patients at risk of syncope. Pacemaker therapy is a feasible and effective method of treatment in young children and relieves symptoms
由于先天性完全性房室传导阻滞患者最初发生的阿-斯综合征有时可能是致命的，因此有必要能够识别出有发生此类发作高风险的患者。对24例先天性完全性房室传导阻滞患儿进行了1至19年的随访，以确定当前预测阿-斯晕厥风险方法的有效性以及起搏器治疗缓解症状的有用性。比较了有晕厥和无晕厥患儿的静息心率、体表心电图复合波形态、心内电生理研究获得的数据以及分级运动平板试验的反应。8名患儿经历了1次或多次阿-斯发作，其中1例死亡。只有静息心率持续低于50次/分钟与晕厥发生率有任何显著（概率[p]小于0.01）相关性。心内电生理研究几乎没有帮助，因为阻滞部位与晕厥无关。尽管运动平板试验期间心率的增加与晕厥发生率或阻滞部位无关，但运动诱发的室性早搏可能对大龄儿童和年轻人有预测价值。10名患儿植入了心室起搏器。在1至10年的随访期内，每个患儿均无症状。由于极度心动过缓可能导致先天性完全性房室传导阻滞患儿阿-斯发作的发生率增加，仔细评估静息心率可能是区分有晕厥风险患者的有效方法。起搏器治疗对幼儿是一种可行且有效的治疗方法，可缓解症状
