乙酰胆碱诱发冠状动脉痉挛试验中缓慢型心律失常的原因探讨

目的探讨乙酰胆碱诱发冠状动脉痉挛试验中缓慢型心律失常的发生原因。方法64例因静息性胸痛而接受冠状动脉造影的患者,排除具有缺血意义的病变后进行乙酰胆碱试验,术中连续记录心电图变化,比较痉挛组和非痉挛组缓慢型心律失常情况,并选择冠状动脉痉挛合并缓慢型心律失常的25例患者分别在冠状动脉内注射硝酸甘油及静脉注射阿托品后重复乙酰胆碱试验,观察冠状动脉痉挛和心律失常的变化情况。结果乙酰胆碱试验痉挛组(46例)和非痉挛组(18例)缓慢型心律失常的发生率无差异(P>0.05),痉挛组中14例经过冠状动脉内注射硝酸甘油后重复乙酰胆碱试验均未能诱发痉挛,但12例仍出现缓慢型心律失常,另11例静脉注射阿托品后重复乙酰胆碱试验均未诱发冠状动脉痉挛,仅1例出现缓慢型心律失常。结论乙酰胆碱试验中的缓慢型心律失常可能与乙酰胆碱的药理作用有关而与冠状动脉痉挛无关。

Investigation on the causes of arrhythmias during acetylcholine test of provoking coronary artery spasm

Objective To investigate the causes of arrhythmias during acetylcholine test of provoking coronary artery spasm. Methods Sixty-four patients with rest chest pain but without significant coronary artery stenosis by coronary angiography were undergone acetylcholine test. Electrocardiogram was continuously recorded during acetylcholine test to compare the arrhythmias including brachycardia, atrioventricular block and cardiac arrest between patients with and without coronary artery spasm. Acetylcholine test was repeated after intracoronary nitroglycery or intravenous atropine in the twenty-five patients with coronary artery spasm and arrhythmias. Changes of arrhythmias and coronary artery spasm were compared before and after intracoronary nitroglycery or intravenous atropine. Results There was no remarkable difference in the incidence of arrhythmias in two groups of with and without coronary artery spasm. Intracoronary nitroglycery could prevent episode of spasm but not arrhythmias while intravenous atropine could prevent both of spasm and arrhythmias. Conclusion The arrhythmias during acetylcholine test might be induced by pharmacological effect of acetylcholine but not coronary artery spasm.