Chen S A, Lee S H, Wu T J, Chiang C E, Cheng C C, Tai C T, Chiou C W, Ueng K C, Wen Z C, Chang M S
National Yang-Ming University, School of Medicine, Taiwan, R.O.C.
J Am Geriatr Soc. 1995 Dec;43(12):1370-7. doi: 10.1111/j.1532-5415.1995.tb06616.x.
To evaluate the clinical features electrophysiologic characteristics, and possible facilitating factors in older patients (> or = 65 years) with initial onset of accessory pathway-mediated and atrioventricular (AV) node reentrant tachycardia.
Of the patients undergoing electrophysiologic study and radiofrequency catheter ablation of accessory pathway-mediated and AV node reentrant tachycardia at this institution, patients with initial tachyarrhythmia after age 65 years were compared with those presenting initially before age 30.
A tertiary medical center for the general public.
Sixty-six patients had their initial symptoms after age 65: Group I, 32 patients with accessory pathway-mediated tachycardia, and Group II, 34 patients with AV node reentrant tachycardia. Four-hundred forty patients had their initial symptoms before age 30: Group III, 283 with accessory pathway mediated tachyarrhythmia, and Group IV, 157 with AV node reentrant tachycardia.
All patients underwent electrophysiological study to determine the mechanisms of tachyarrhythmia, and radiofrequency catheter ablation for treatment of tachycardia.
(1) Older patients with initial arrhythmia had incidence of critical clinical manifestations, including tachyarrhythmia-related syncope and cardioversion, similar to those with initial arrhythmia at a younger age. (2) Patients in Group III, showed anterograde effective refractory period (ERP) of the AV node (P = .432), longer anterograde ERP of the accessory pathway (P = .004), and greater difference of the anterograde ERP between the AV node and the accessory pathway (D-ERP) (P = .003) similar to patients in group I. In Group II, the ERP and Wenckebach cycle length of the retrograde fast pathway was significantly longer than in Group IV (P = .037 and P < .001, respectively), and a greater percentage of patients in Group II than in Group IV AV node reentrant tachycardia needed isoproteronol to facilitate the induction of reentrant tachycardia (P = .034). (3) Patients in Group I and Group II had a higher incidence of supraventricular and ventricular ectopic activity than those in Group III (P = .002 and P = .005, respectively) and Group IV (P = .024 and P = .012, respectively) in 24-hour ambulatory electrocardiograms.
The initial onset of accessory pathway-mediated tachycardia after age 65 may be caused by changes of electrophysiologic properties (greater D-ERP) as well as increased supraventricular and ventricular ectopic activity. Influence of the autonomic nervous system, rather than changes of conduction properties in the AV node, and increase in ectopic activity may contribute to the new onset of AV node reentrant tachycardia in older adults. The choice of antiarrhythmic drugs and radiofrequency ablation require attention to the clinical profile and facilitating factors of reentrant tachycardia in this group of patients.
评估老年患者（≥65岁）初发的房室旁道介导性和房室结折返性心动过速的临床特征、电生理特性及可能的促发因素。
在本机构接受房室旁道介导性和房室结折返性心动过速的电生理研究及射频导管消融治疗的患者中，将65岁以后初发心律失常的患者与30岁以前初发的患者进行比较。
一所面向普通大众的三级医疗中心。
66例患者在65岁以后出现初始症状：第一组，32例房室旁道介导性心动过速患者；第二组，34例房室结折返性心动过速患者。440例患者在30岁以前出现初始症状：第三组，283例房室旁道介导性快速心律失常患者；第四组，157例房室结折返性心动过速患者。
所有患者均接受电生理研究以确定快速心律失常的机制，并接受射频导管消融治疗快速心律失常。
（1）初发心律失常的老年患者出现严重临床表现的发生率，包括与快速心律失常相关的晕厥和心脏复律，与年轻时初发心律失常的患者相似。（2）第三组患者的房室结前向有效不应期（ERP）（P = 0.432）、房室旁道前向ERP较长（P = 0.004），且房室结与房室旁道之间的前向ERP差值（D-ERP）较大（P = 0.003），与第一组患者相似。在第二组中，逆向快径的ERP和文氏周期长度显著长于第四组（分别为P = 0.037和P < 0.001），且第二组中需要异丙肾上腺素来促进折返性心动过速诱发的房室结折返性心动过速患者的比例高于第四组（P = 0.034）。（3）在24小时动态心电图中，第一组和第二组患者的室上性和室性异位活动发生率高于第三组（分别为P = 0.002和P = 0.005）和第四组（分别为P = 0.024和P = 0.012）。
65岁以后初发的房室旁道介导性心动过速可能由电生理特性改变（更大的D-ERP）以及室上性和室性异位活动增加所致。自主神经系统的影响，而非房室结传导特性的改变以及异位活动的增加，可能导致老年患者新发房室结折返性心动过速。在这组患者中，抗心律失常药物的选择和射频消融需要关注折返性心动过速的临床特征和促发因素。
