心室停搏大于三秒临床意义与起搏器应用商榷.docVIP

心室停搏大于三秒临床意义与起搏器应用商榷 心室停搏大于三秒的临床意义及起搏器应用的商榷 2011-09-15 钱秉源　王龙华　王建平 　　【摘要】　目的　探讨心室停搏大于3秒作为安置起搏器的指征是否合适。方法　收集动态心电图(DCG)检查中具有3秒以上RR间期的79例病例，分析心室停搏的发生原因及起搏器应用情况对生存率的影响。结果　6 180例次Holter记录中心室停搏大于3秒79例(86例次1.4%)。心室停搏发生于心房纤颤(房颤)心房扑动(房扑)中27例(34.2%)，房室传导阻滞3例(3.8%)，房颤、房扑终止后19例(24.0%)，室上性心动过速终止后9例(11.4%)，窦性停搏及Ⅱ度窦房传导阻滞21例(26.6%)。起搏组及非起搏组各死亡3例，两组3年生存率无差异。结论　安置起搏器要结合心室停搏的原因及相关症状而定，对发生在房颤、房扑中的长时间心室停搏一般不必安置起搏器，对无症状的病窦综合征患者推迟安置起搏器是安全的。 　　【关键词】　心律失常　　心电描记术，便携式　　心脏起搏，人工 Significance of ventricular pauses of 3 seconds or more and deliberation for the implantation of a permanent pacemaker　　Qian Bingyuan, Wang Longhua, Wang Jianping. Department of Electrocardiogram, Anzhen Hospital, Capital Medical University, Beijing 100029 　　【Abstract】　Objective　Ventricular pauses of 3 seconds or more is proposed by the clinicians in China and abroad as a definite indication for the implantation of a permanent pacemaker at present, but we think it is worth deliberating further. Methods　24 hour Holter recordings with the occurrence of ventricular pauses of 3 seconds or more were collected and analyzed together with the clinical history. Variables analyzed were clinical history, causes of the ventricular pauses, relationship of clinical symptoms with ventricular pauses and use of permanent pacing affecting the actuarial survival probabilities. Results　6 180 consecutive 24 hour Holter recordings were reviewed for the presence of ventricular pauses of at least 3 seconds. 79 patients (1.4% of total), 46 men and 33 women, were identified. Causes of the pauses were atrial fibrillation/atrial flutter with slow ventricular response in 27 patients (34.2%), atrioventricular block in 3 patients (3.8%), pause after termination of atrial fibrillation/atrial flutter in 19 (24.0%), pause after termination of supraventricular tachycardia in 9 (11.4%), and sinus arrest/Ⅱ° sinus atrial block in 21 (26.6%). Thirteen of the 79 had dizziness during the pauses. 39 patients received permanent pacemakers. 40 patients were