Menozzi C, Brignole M, Lolli G, Bottoni N, Oddone D, Gianfranchi L, Gaggioli G
Laboratory of Electrophysiology and Pacing, Ospedale S. Maria Nuova, Reggio Emilia, Italy.
Am J Cardiol. 1993 Nov 15;72(15):1152-5. doi: 10.1016/0002-9149(93)90985-l.
The occurrence rate of spontaneous asystolic episodes during long-term follow-up in patients with abnormal asystolic responses induced by means of vasovagal maneuvers was evaluated. The heart rate of 23 patients (mean age 64 +/- 12 years; 6 women and 17 men) affected by neurally mediated syncope (mean 4.3 +/- 4.9 episodes) was continuously monitored by a specially designed implanted pacemaker able to detect and store in its memory all asystolic episodes lasting 3 to 6 or > 6 seconds. Asystolic, neurally mediated syncope was diagnosed when a reflex asystole of > 3 seconds was induced during carotid sinus massage (n = 22), eyeball compression test (n = 3) or head-up tilt test (n = 2). During a total of 357 months (mean 15 +/- 7) of monitoring, asystolic episodes occurred in 17 patients (74%): 1,765 episodes of 3- to 6-second (median 3) duration occurred in 14 patients, and 47 episodes of > 6-second (median 2) duration occurred in 11. The actuarial estimates of occurrence of asystolic episodes of > 3 and > 6 seconds were 82 and 53%, respectively, after 2 years of follow-up. Only 12 episodes of 3 to 6 seconds (0.7%), and 20 episodes of > 6 seconds (43%) resulted in presyncopal or syncopal symptoms. Thus, an asystolic response to vasovagal maneuvers predicts the occurrence of spontaneous asystolic episodes during follow-up. With few exceptions, spontaneous episodes are asymptomatic and their incidence is low.
对通过迷走神经手法诱发心脏停搏反应异常的患者进行长期随访期间，评估了自发性心脏停搏发作的发生率。通过专门设计的植入式起搏器对23例（平均年龄64±12岁；6名女性和17名男性）神经介导性晕厥患者（平均4.3±4.9次发作）的心率进行连续监测，该起搏器能够检测并将所有持续3至6秒或>6秒的心脏停搏发作存储在其内存中。当在颈动脉窦按摩（n = 22）、眼球压迫试验（n = 3）或头高位倾斜试验（n = 2）期间诱发>3秒的反射性心脏停搏时，诊断为心脏停搏性神经介导性晕厥。在总共357个月（平均15±7个月）的监测期间，17例患者（74%）出现了心脏停搏发作：14例患者出现了1765次持续3至6秒（中位数3秒）的发作，11例患者出现了47次持续>6秒（中位数2秒）的发作。随访2年后，持续>3秒和>6秒的心脏停搏发作的精算估计发生率分别为82%和53%。只有12次3至6秒的发作（0.7%）和20次>6秒的发作（43%）导致了晕厥前期或晕厥症状。因此，对迷走神经手法的心脏停搏反应可预测随访期间自发性心脏停搏发作的发生。除少数例外，自发性发作无症状且发生率较低。
