Raybaud F, Camous J P, Tibi T, Baudouy M, Morand P
Service de cardiologie, hôpital Pasteur, Nice.
Arch Mal Coeur Vaiss. 1995 Jan;88(1):27-33.
The prevalence of arrhythmia increases with age. Considered as an "ordinary" event in elderly patients, these arrhythmias may nevertheless have serious consequences. This study was undertaken to determine the clinical, aetiological and prognostic features of serious arrhythmias in a population of elderly subjects (> or = 70 years) hospitalised over a 20 months period and comprising 202 patients (103 women, 99 men, mean age 79.6 +/- 5.9 years). Supraventricular arrhythmias are the most common by far (84.2%): 51.4% of patients had atrial fibrillation, 15.3% had atrial flutter; 12.9% had focal atrial tachycardia, 4.5% had junctional tachycardia. Of the ventricular arrhythmias (15.8%), there were 12 sustained ventricular tachycardias, 4 torsades de pointes and 1 ventricular fibrillation. The increased duration of hospital stay (10 +/- 6 days on average) is related not to age but to the type of arrhythmia (longer for ventricular arrhythmias) and to left ventricular dysfunction. The main complications of arrhythmias were cardiac failure (52.4%), neurological deficits (37.4%) and angina (18.6%). Electrocardiographic signs of atrioventricular block were present in 62% of cases and QRS changes in 47.3% of cases. Ventricular arrhythmias were more commonly associated with intraventricular conduction defects, signs of myocardial necrosis and prolongation of the QT interval; they were also common in patients with left ventricular dysfunction and when the left ventricle was dilated. The aetiology of ventricular arrhythmias was mainly iatrogenic (50%) and ischaemic (21.8%), whereas the aetiologies of the supraventricular arrhythmias were varied, 14.7% of cases being idiopathic. Conversion to stable sinus rhythm was obtained in half the patients. A pacemaker was implanted in 10.8% of cases. The hospital mortality was 4.9%.(ABSTRACT TRUNCATED AT 250 WORDS)
心律失常的患病率随年龄增长而增加。在老年患者中，这些心律失常虽被视为“常见”事件，但仍可能产生严重后果。本研究旨在确定在20个月期间住院的202例老年患者（≥70岁，其中103例女性，99例男性，平均年龄79.6±5.9岁）中严重心律失常的临床、病因及预后特征。室上性心律失常最为常见（84.2%）：51.4%的患者患有房颤，15.3%患有房扑；12.9%患有局灶性房性心动过速，4.5%患有交界性心动过速。室性心律失常占15.8%，其中有12例持续性室性心动过速、4例尖端扭转型室速和1例心室颤动。住院时间延长（平均10±6天）与年龄无关，而与心律失常类型（室性心律失常时间更长）及左心室功能不全有关。心律失常的主要并发症为心力衰竭（52.4%）、神经功能缺损（37.4%）和心绞痛（18.6%）。62%的病例存在房室传导阻滞的心电图表现，47.3%的病例有QRS波改变。室性心律失常更常与室内传导缺陷、心肌坏死迹象及QT间期延长相关；在左心室功能不全及左心室扩大的患者中也很常见。室性心律失常的病因主要为医源性（50%）和缺血性（21.8%），而室上性心律失常的病因多种多样，14.7%的病例为特发性。半数患者转为稳定的窦性心律。10.8%的病例植入了起搏器。医院死亡率为4.9%。（摘要截断于250字）
