倾斜试验致心室传导阻滞的心电图特征

贵州医科大学     麻醉与心脏电生理课题组

翻译：刘云琴  编辑：张中伟  审核：曹莹

罂 粟 摘 要 

背景：反射性晕厥时房室传导阻滞的心电图（ECG）特征可能因高迷走神经张力引起的。本研究的目的是确定倾斜试验（TT）引起的心源性神经反射诱发的心室传导阻滞的心电图特征。

方法：对31例TT诱发的疑似血管迷走性晕厥和房室传导阻滞患者进行研究。评估PP/PR间期、房室传导阻滞分度和分型、并发心律失常以及房室传导阻断发生的时间。26例患者在TT终止时出现房室传导阻滞，4例患者在恢复期出现房室传导阻滞，1例患者在两个时期出现房室传导阻断。房室传导阻滞前有窦性减慢，房室传导阻断期间窦性心律节律缓慢而不稳定。Mobitz I、2:1二度房室传导阻滞和晚期二度房室内传导阻滞的患者分别占35.5%、48.4%和67.8%的患者。41.9%的患者诊断为三度房室传导阻滞。21名患者至少有两种房室传导阻滞形式。最常见的伴发心律失常是交界性逸搏心律（61.3%）。

总结：（1）在TT诱发的神经源性心源性神经反应期间，房室传导阻滞的发生总伴随窦性心律减慢，通常是PR间期延长。（2）TT引起的房室传导阻滞通常发生在TT终止时，但即使在恢复期仰卧位也可能发生。有时，在TT终止和恢复期间，房室传导阻滞均可能出现。

原始文献来源：Zyśko D, Gajek J, Koźluk E, et al.. Electrocardiographic characteristics of atrioventricular block induced by tilt testing. Europace. 2009;11(2):225-230.

英文原文 

Electrocardiographic characteristics of

atrioventricular block induced by tilt testing

Abstract

Aims：The electrocardiographic (ECG) characteristics of atrioventricular (AV) block during reflex syncope may be uniquedue to the presence of hypervagotonia. The aim of the present study was to define the ECG characteristics of the AVblock induced by neurocardiogenic reflex provoked by tilt testing (TT).

Methods andresults：A series of 31 patients with presumed vasovagal syncope and AV block provoked by TT was studied. The duration ofPP and PR interval, AV block grade and type, concomitant arrhythmias, and timing of the AV block occurrence wereassessed. The AV block occurred at TT termination in 26 patients, in the recovery in 4 patients, and in both periods in1 patient. Atrioventricular block was preceded by sinus slowing, and sinus rhythm during AV block was slow andinstable. Mobitz I, 2:1 second-degree AV block, and advanced second-degree AV block were recognized in 35.5,48.4, and 67.8% of patients, respectively. Third-degree AV block was diagnosed in 41.9% of patients. Twenty-onepatients had at least two AV block forms. The most prevalent concomitant arrhythmia was junctional escaperhythm (61.3%).

Conclusion：(i) The occurrence of the AV block during neurocardiogenic reaction induced by TT is always preceded by sinusrhythm slowing and usually by PR interval prolongation. (ii) The AV block provoked by TT usually occurs at TT ter-mination, but may occur even in the recovery period in a supine position. Sometimes the AV block may be presentboth at TT termination and during the recovery period.

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