心室起搏发生室房传导与返复心律的临床分析

随访２３例心室起搏后出现室房传导者，其Ｓ－Ｐ（Ｓｐｉｋｅ－Ｐｗａｖｅ）时间为２６７±１３０（１６０～６４０）ｍｓ。其中１５例心电图仅呈现逆行传导的Ｐ（Ｐ）波，８例同时出现返复心律；１１例临床上有不同程度的起搏器综合征表现。有与无起搏器综合征者Ｓ－Ｐ时间比较无明显差异（２０３．３±２９．０ｍｓｖｓ１９０．０±２６．２ｍｓ，Ｐ＞０．０５）。临床症状与返复心律出现的频率及Ｓ－Ｐ时间有关。本组６例起搏器综合征患者血液动力学结果：①右房压升高。②股动脉压持续降低（＞２．７ｋＰａ）。③动脉压呈波动性下降。④有返复心律时室压波动。这四种情况可以单独出现或并存。血液动力学变化与逆传激动激活房壁及肺静脉壁压力感受器反射性导致血压和颅内压下降、心排血量降低等有关

Clinical Analysis of the Ventriculoatrial Conduction and Reentry Rhythm in Patients Undergoing Pacemaker Implantation

Twenty three patients with retrograde (V A) conduction of implanted VVI pacemakers were followed, spike P wave time was 267±130(160～640) ms.Among them,15 cases showed only retrograde conducted P wave in the electrocardiogram, while 8 cases showed reentry rhythm, 11 cases showed pacemaker syndrome symptom of different severity. There was no significant difference in the V A conduction time between patients with and without pacemaker syndrome, it was 203.3±29.0(160～230) ms in the former group and 190.0±26.2(160～280) ms in the latter group( P >0.05). Clinical symptom had a significant relationship with a short coupling interval and the frequency of the appearance of the reentry rhythm, the short coupling interval affected fully cardiac refill and cardiac output. The results of hemodynamic study in 6 patients with pacemaker syndrome were:(1)increased atrial pressure;(2)sustained lowering of the arterial pressure(>2.7 kPa);(3)lowering of the arterial pressure with fluctuation;(4)fluctuation of ventricular pressure during reentrant rhythm; these four conditions might appear singly or simultaneously. The mechanisms of the hemodynamic change might be that the stimulation of pressure receptors of the atrial wall and pulmonary vein by the retrograde conduction wave might reflexively lead to the lowering or fluctuaing of blood pressuer and intracranial pressure, the elevation of pressure in the venous system, lowering of the cardiac output and others changes.