Dabrowski A, Krupienicz A, Kołodziej P, Piotrowicz R
Zakładu Kardiometrii i I Kliniki Chorób Wewnetrznych Instytutu Medycyny Wewnetrznej Centralnego Szpitala Klinicznego WAM, Warszawie.
Kardiol Pol. 1993 Jul;39(7):4-8; discussion 9.
Holter monitoring is one of the most commonly done test in the evaluation of patients with syncope. As Holter monitoring may miss an arrhythmia or document an asymptomatic arrhythmia invasive electrophysiologic testing has been applied in patients with syncope. The purpose of this study was to compare Holter monitoring and electrophysiologic tests in patients with syncope of unexplained origin. The group consisted of 100 patients with syncope of unknown origin. Coronary artery disease was present in 43 patients, other heart disease in 19 patients and no structural heart disease was found in 38 patients. Electrophysiological testing consisted of (1) recording of His bundle electrogram, (2) atrial stimulation, (3) ventricular stimulation with 1.2 and 3 extrastimuli at three basic cycle lengths. The results of Holter monitoring were classified by severity of abnormalities into three classes: I--normal study; II--moderate abnormalities; III--severe abnormalities: sinus rhythm with pauses longer than 3 s, Mobitz II or complete atrio-ventricular block, supraventricular arrhythmia faster than 180 bpm, sustained ventricular tachycardia. Abnormalities of electrophysiologic testing were grouped as: I normal study; II--moderate abnormalities; III--severe abnormalities: sinus nodal recovery time more than 3 s, HV interval longer than 100 ms, supraventricular arrhythmia faster than 200 bpm, sustained ventricular tachycardia. Class III abnormalities were documented in 17 patients on Holter monitoring and in 20 patients by electrophysiologic testing. Compatibility between class III abnormalities in Holter monitoring and electrophysiological testing was noted in 4 patients, discordance of class III results in 33 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
动态心电图监测是评估晕厥患者时最常用的检查之一。由于动态心电图监测可能会漏诊心律失常或记录到无症状性心律失常，因此侵入性电生理检查已应用于晕厥患者。本研究的目的是比较不明原因晕厥患者的动态心电图监测和电生理检查。该组包括100例不明原因晕厥患者。43例患者存在冠状动脉疾病，19例患者有其他心脏病，38例患者未发现结构性心脏病。电生理检查包括：（1）希氏束电图记录；（2）心房刺激；（3）在三个基本周期长度下用1.2次和3次额外刺激进行心室刺激。动态心电图监测结果按异常严重程度分为三类：I类——检查正常；II类——中度异常；III类——严重异常：窦性心律伴停搏超过3秒、莫氏II型或完全房室传导阻滞、室上性心律失常快于180次/分、持续性室性心动过速。电生理检查异常分为：I类——检查正常；II类——中度异常；III类——严重异常：窦房结恢复时间超过3秒、HV间期长于100毫秒、室上性心律失常快于200次/分、持续性室性心动过速。动态心电图监测中有17例患者记录到III类异常，电生理检查中有20例患者记录到III类异常。4例患者动态心电图监测和电生理检查的III类异常结果相符，33例患者III类结果不一致。（摘要截断于250字）
