Hagendorff A, Pizzulli L, Dettmers C, Block A, Omran H, Hartmann A, Manz M, Lüderitz B
Medizinische Universitätsklinik Bonn.
Z Kardiol. 1994 Dec;83(12):908-11.
A pacemaker syndrome manifested as transient sensoric aphasia in a 68-year-old woman with a VVI-pace-maker implanted after SA-block. The attack occurred during long-term blood pressure recording and Holter monitoring. Borderline hypotension was documented during ventricular pacing which induced a retrograde excitation of the atrium. Clinical investigations excluded any intracranial abnormality, any source of embolism or stenosis of extra- and intracranial cerebral arteries. Cerebral blood flow measurements revealed a significant increase during pacing at elevated heart rate. Therefore, a device for AV-sequential pacing was implanted and basic pacing rate was elevated. The present case report indicates that focal and not only global cerebral ischemia can be produced by an impairment of systemic hemodynamics due to hypotension and a pacemaker syndrome. Improvement of cerebral blood flow during pacing is an unexpected finding contrasting with the concept of autoregulation. In addition, pacemaker implantation should be discussed in patients with transient cerebral perfusion deficits if an improvement of cerebral blood flow is documented along with rising heart rate.
一名68岁女性在发生窦房阻滞后植入VVI起搏器，出现了以短暂性感觉性失语为表现的起搏器综合征。发作发生在长期血压记录和动态心电图监测期间。心室起搏时记录到临界低血压，这导致了心房的逆行激动。临床检查排除了任何颅内异常、任何栓塞源或颅内外脑动脉狭窄。脑血流测量显示，在心率升高时起搏期间脑血流显著增加。因此，植入了房室顺序起搏装置，并提高了基本起搏频率。本病例报告表明，低血压和起搏器综合征导致的全身血流动力学损害可引起局灶性而非仅为全身性脑缺血。起搏期间脑血流的改善是一个与自动调节概念相反的意外发现。此外，如果记录到随着心率上升脑血流有所改善，对于有短暂性脑灌注不足的患者，应讨论起搏器植入问题。
