Solti F, Bodor E, Merkely B, Kovács E, Kalmár I, Gyöngy T
Er- és Szívsebészeti Klinika, Semmelweis Orvostudományi Egyetem, Budapest.
Orv Hetil. 1993 Oct 10;134(41):2249-53.
The appearance of long lasting bradycardia due to damage of the sinus node (iatrogen sick sinus syndrome; or the atrioventricular conduction system, iatrogen AV block) is not a rare event after open heart surgery. In the course of 5093 heart operations the development of iatrogen sick sinus syndrome was observed in 234 patients (4.6%) and iatrogen AV block in 91 cases (1.8%). The incidence rate of iatrogen sick sinus syndrome or iatrogen AV block was quite divergent depending mostly on the type of operation. Comparing the data of our earlier (1977-1982) and later (1983-1991) cardiac surgical interventions, the prevalence of iatrogen sinus node disease and iatrogen AV block seems to decrease, mainly due to the progress in techniques of cardiac surgery. With the appearance of iatrogen sick sinus syndrome or AV block, urgent temporary pacing is indicated to prevent the deleterious hemodynamic effect of bradycardia. In the cases of persistent iatrogen sick sinus syndrome and iatrogen AV block, permanent pacemaker implantation is needed. It is remarkable that although the incidence rate of iatrogen sick sinus syndrome is greater than that of iatrogen AV block, in iatrogen sick sinus syndrome the regression is quite frequent, while in iatrogen AV block the 2nd or 3rd degree AV block is usually permanent. We performed pacemaker implantation in 56 cases of iatrogen sick sinus syndrome (24%) and in 57 patients of iatrogen AV block (63%). With pacemaker therapy the outcome of iatrogen sick sinus syndrome and iatrogen AV block is very favourable.
由于窦房结损伤（医源性病态窦房结综合征）或房室传导系统损伤（医源性房室传导阻滞）导致的持续性心动过缓，在心脏直视手术后并非罕见。在5093例心脏手术过程中，观察到234例患者（4.6%）发生医源性病态窦房结综合征，91例患者（1.8%）发生医源性房室传导阻滞。医源性病态窦房结综合征或医源性房室传导阻滞的发生率差异很大，主要取决于手术类型。比较我们早期（1977 - 1982年）和后期（1983 - 1991年）心脏外科手术的数据，医源性窦房结疾病和医源性房室传导阻滞的患病率似乎有所下降，这主要归因于心脏手术技术的进步。出现医源性病态窦房结综合征或房室传导阻滞时，需紧急临时起搏以防止心动过缓对血流动力学产生有害影响。对于持续性医源性病态窦房结综合征和医源性房室传导阻滞的病例，则需要植入永久性起搏器。值得注意的是，尽管医源性病态窦房结综合征的发生率高于医源性房室传导阻滞，但医源性病态窦房结综合征相当常见的是可恢复，而医源性房室传导阻滞中的二度或三度房室传导阻滞通常是永久性的。我们对56例医源性病态窦房结综合征患者（24%）和57例医源性房室传导阻滞患者（63%）进行了起搏器植入。通过起搏器治疗，医源性病态窦房结综合征和医源性房室传导阻滞的预后非常良好。
