由冠状动脉痉挛引起的心律失常的处理及随访

目的探讨由冠状动脉(简称冠脉)痉挛引起心律失常的处理方法及有效性。方法8例晕厥发作时心电图提示下壁导联ST段抬高伴完全性房室传导阻滞,2例胸闷继发黑矇,无症状发作时心电图正常。明确无水、电解质紊乱后,予以心脏超声、动态心电图、心电监护、冠脉造影检查,明确诊断和病因后予以相应的处理。结果10例生化及心脏超声正常。8例发作性Ⅲ度房室传导阻滞入院的患者,除1例发现右冠脉开口狭窄20%～30%外,其余患者冠脉造影均正常,均置入单腔心室起搏器后使用钙拮抗剂。2例胸闷伴黑矇患者中的1例,造影前Holter发现V1～V6导联ST段抬高伴短阵室性心动过速(简称室速),冠脉造影发现左前降支近段粥样斑块形成,狭窄程度<50%,考虑室速发生的原因是粥样斑块基础上痉挛所致,直接支架植入。另1例造影前无症状发作,造影发现左前降支近段粥样斑块形成,狭窄程度<50%,未予干预,当晚患者症状再发,心电监护发现V1～V6导联ST段抬高伴短阵室速,考虑室速发生的原因与上相同,急诊植入支架。所有患者随访6月至11年,均健在,无类似发作,生活状况良好。结论对于冠脉痉挛引起的心律失常,针对其病变基础采用稳定斑块、起搏支持下的抗痉挛治疗有效。

Management of arrhythmia induced by coronary artery spasm.

Objective To report the effect of management of arrhythmia induced by coronary artery spasm.Method Ten patients with syncope or pre-syncope were enrolled in the study,eight patients with complete atrial-ventricular block and inferior ST segment elevation with no-evidence to make the diagnosis clear in the other two patients.All patients accepted the arrhythmia monitoring and coronary angiography(CAG).Results All patients had normal electrolyte and heart structure.Eight patients had normal CAG,the combinatio...