病态窦房结综合征动态心电图特征及其临床意义

目的 探讨病态窦房结综合征(SSS)者动态心电图(DCG)特征及临床意义，对101例SSS者进行回顾性分析。方法 依DCG特征分为Ⅳ型：I型[持续而严重的窦性心动过缓(SB)]16例(占15．8％)；Ⅱ型(SB伴窦性停搏或窦房阻滞)34例(占33．7％)；Ⅲ型(慢—快综合征及快—慢综合征)23例(占22．8％)；Ⅳ型(双结病变)28例(占27．7％)。结论 植入合适的永久人工心脏起搏器，对重症缓慢性心律失常及快速心律失常可起到良好的治疗作用。     

病态窦房结综合征研究进展

病态窦房结综合征(sick sinus syndrome,SSS)简称病窦,由窦房结及其邻近组织病变,引起窦房结起搏功能障碍或窦房传导阻滞,而导致多种心律失常和临床表现,常见病因为冠心病、心肌炎、心肌病等,原因不明者约占37%,发病机制尚未明确,多于40岁以上出现症状,临床表现为心、脑、肾等重要脏器供血不足,出现心悸、胸闷、气短、晕厥等,甚至猝死,近年来对病窦的研究从实验研究到临床观察逐渐增多,现综述如下.     

病态窦房结综合征

病态窦房结综合征(sicksinussyndrome,SSS)是心源性昏厥的原因之一,是心血管比较常见的严重疾病,主要是窦房结(SAN)的器质性病变或功能性障碍,造成起搏和传导功能失常,以致产生一系列的心律紊乱、血流动力学障碍和心功能受损,严重者可发生阿-斯综合征或猝死,临床上已引起普遍重视。一、窦房结的解剖生理特点1. 细胞组成。(1)起搏细胞(pacemakercell)又称P细胞,位于窦房结中央,因肌原纤维少,不具收缩功能,只发放冲动,维持心脏节律性活动。P细胞受损,窦房结自律性降低或冲动形成障碍。(2)过渡细胞(transitionalcell)又称T细胞、移行细胞,…     

24h动态心电图诊断病态窦房结综合征61例

病态窦房结综合征 (ＳＳＳ)是指窦房结及其周围的器质性病变 ,引起窦性激动发放过缓、激动形成或窦房传导障碍等心律失常。其病因包括窦房结动脉疾病 (如冠心病、炎症性疾病、风心病、特发性心肌纤维化等 ) ,心肌病、高血压、二尖瓣脱垂综合征 ,但以冠心病居首位[1] 。早期诊断 ,合理治疗可以显著降低其病残率和死亡率。ＳＳＳ可导致心、脑、肾等重要器官供血不足 ,包括心悸、头晕、晕厥、眼前发黑、诱发或加重心绞痛、心力衰竭 ;严重时可发生阿 -斯氏综合征或猝死。各年龄组均可发生 ,以中老年多见 ,诊断时 ,经常需与晕厥或晕厥前期的其他…     

心房颤动与病态窦房结综合征的关系

目的对心房颤动(Af)与病态窦房结综合征(SSS)进行相关性分析。方法对166例常规心电图检查为阵发性Af的住院者依次于第1次、24h动态心电图(DCG)检查后半年、1年、2年、3年分别再次进行24h检查。观察其SSS患病率。结果166例阵发性Af者检出SSS数逐年递增。结论阵发性Af明显增加SSS患病率。     

88例病态窦房结综合征动态心电图分析

本文收集了 1993年 5月～ 1998年11月在我院确诊为病态窦房结综合征(ＳＳＳ)的 88例资料 ,从动态心电图的角度进行分析讨论。1　资料与方法88例患者均为我院住院及门诊病人 ,其诊断依据北京地区病窦座谈会制定的标准[1 ] 。其中男 69例、女 19例 ,年龄 2 3～ 85 (平均 61 8)岁 ,本组患者均有胸闷、头晕症状 ,2 7例伴有黑蒙及晕厥。病因 :冠心病 44例 (其中 1例合并Ｂ型ＷＰＷ) ,传导系统退行性改变 2 8例 ;高血压Ⅱ～Ⅲ期 10例 ,心肌炎 3例 ,扩张性心肌病 2例 ,风心 1例。动态心电图 (ＤＣＧ)连续监测 2 3～2 4ｈ ,被检查者于检查前 2ｄ未服…     

氨茶碱治疗病态窦房结综合征的疗效分析

目的:探讨氨茶碱治疗病态窦房结综合征的疗效。方法:选择本院住院的62例病态窦房结综合征患者,随机分为氨茶碱治疗组(32例)和对照组(30例),对照组按常规治疗;氨茶碱治疗组在常规治疗的基础上加用氨茶碱,一个疗程10天。结果:氨茶碱组治疗的总有效率为84.4％,与对照组的60％比较有显著差异(P<0.05)。结论:常规治疗加用氨茶碱治疗病态窦房结综合征是一种有效的方法。     

动态心电图对病态窦房结综合征的分析

本文收集了2000年1月～2003年6月问常规心电图(ECG)检查的240例门诊及住院窦缓患者,进行动态心电图(DCG)监测病窦(SSS)94例,报告如下。     

动态心电图诊断病态窦房结综合征1例

患者女,70岁。反复发作上腹部胀痛半年。加重1月,以左肝管结石入院。既往无昏厥史。拟手术治疗。体检：T36．6℃,P45次／min、BP90／60mmHg,神态清楚。心前区无隆起,心界不大,心率45次／min。可闻及早搏,心音正常,无明显病理性杂音。常规心电图示窦性心动过缓、房性早搏、交接性逸搏、不完全性右束支传导阻滞。为进一步明确诊断。遂作动态心电图。24h总心搏数为68720次。平均心律51次／min,     

病态窦房结综合征49例临床分析

笔者就观察的病态窦房结综合征(病窦)49例报告如下:1　资料与方法1.1　临床资料1.1.1　一般资料:1996年1月至1998年8月,住院病窦病人共49例,其中男30例,女19例;年龄29～67岁,平均43.2岁;病程3个月至14年。29～39岁9例,占18.3%,40～50岁33例,占67.4%,>60岁7例,占14.2%。1.1.2　诊断:全部病人均按1977年北京会议制定标准诊断,49例病人阿托品试验均呈阳性,其中31例做了经食道心房调搏窦房结功能测定,均符合病窦诊断。1.1.3　病因:冠心病28例(57.1%),高血压病7例(14.2%),风心病3例(6.1%),心肌病9例(18.3%),原因不明2例(4.0%)。1.1.4　心律失常类…     

窦房结动脉的影像学评价及其与病态窦房结综合征的关系

目的　了解冠状动脉(冠脉)造影下窦房结动脉(sinusnodeartery ,SNA)的形态与起源,明确窦房结动脉相关病变与病态窦房结综合征(sicksinussyndrome ,SSS)的关系。方法　连续观察51 1人的冠脉造影资料,比较有无窦房结动脉相关病变的两组各2 9人的心率和SSS发病情况,以及有无SSS和(或)窦性心动过缓的两组各34人的窦房结动脉相关病变情况。数据采用SPSS1 0 0软件包进行统计分析处理。结果　51 1人中观察到50 6人的窦房结动脉共56 1支,其中53人( 1 0 . 1 7% )有双SNA ,1人有三支SNA。右、左和后窦房结动脉分别为2 75支( 4 9. 0 2 % )、2 0 5支( 36 . 54% )和81支( 1 4 . 4 4% )。有无窦房结动脉相关病变的两组平均心率( 71 . 59±7 .4 5次 分vs 73 .76±6 . 6 7次 分)及患SSS患者数量( 1人vs 0人)的差异无统计学意义(P >0 0 5)。SSS组和非SSS组窦房结动脉受累情况(SSS组34人有2人狭窄4 0 %和90 % ,非SSS组34人有2人狭窄4 5%和2 0 % )的差异无统计学意义(P >0 .0 5)。结论　冠脉造影下基本可以清晰地看到窦房结动脉。窦房结动脉相关病变与SSS关系不大。     

腺苷对病态窦房结综合征与阵发性室上性心动过速影响的研究

目的探讨腺苷对病态窦房结综合征(SSS)和阵发性室上性心动过速的影响。方法17例SSS(1组),19例阵发性室上性心动过速(2组)和46例健康受试者(3组)。用大剂量腺苷及食管调搏术测定窦房结恢复时间(SNRT)、矫正后的窦房结恢复时间(CSNRT)及ADO:CSNRT(腺苷激发后的CSNRT)。结果SNRT长于2200ms和CSNRT长于550ms判定窦房结功能异常。食管调搏法CSNRT1组(3173.80±3377.07)ms,2组(342.59±264.54)ms,3组(282.45±83.24)ms;SNRT1组(4372.80±3159.58)ms,2组(1039.41±322.45)ms,3组(1016.45±85.22)ms;ADO1组(1921.25±1713.65)ms,2组未影响,3组未影响,组间差异有统计学意义(P<0.001)。结论腺苷对SSS的诊断有意义,而对阵发性室上性心动过速无影响。     

改良型阿托品试验的探讨

目的:探讨阿托品试验改良法对窦房结功能的诊断价值.方法:取2008年6月至2009年9月在我院行阿托品试验的患者,均经其他检查(动态心电图或心电图)诊断为窦性心动过缓,共220例.分为常规组和改良组,行阿托品试验.结果:常规组阳性33例,占30.5%,改良组阳性16例,占15.7%.结论:常规阿托品试验法存在一定的假阳...     

Atrial pacing for sick sinus syndrome

Atrial pacing is the most physiological way to pace patients with sinus node disease, as it provides both AV synchrony and a normal ventricular activation pattern. Long-term studies comparing atrial and ventricular pacing imply that atrial pacing results in fewer cardiac complications and, possibly, reduced mortality. Ventricular pacing should thus, if possible, be avoided in patients with sinus node disease. The potential risk of impending high-grade AV block during atrial pacing is low, with an annual incidence around 1% if patients are selected appropriately. Approximately 40-50% of patients with sinus node disease show signs of chronotropic incompetence during physical exercise, and are thus candidates for atrial rate responsive pacing. A preoperative evaluation of candidates for atrial pacing should include long-term Holter/telemetry, exercise test, carotid sinus stimulation, and an electrophysiological study excluding significant AV conduction disturbances.     

The value of adenosine test in the diagnosis of sick sinus syndrome: susceptibility of sinus and atrioventricular node to adenosine in patients with sick sinus syndrome and unexplained syncope.

AIMS: Patients (pts) with sick sinus syndrome (SSS) and unexplained syncope show increased susceptibility of sinus and atrioventricular node (AVN) to intravenous adenosine, respectively. Our aim is to assess the diagnostic value of adenosine test in pts with SSS, as well as to evaluate the response of AVN to adenosine either in pts with unexplained syncope or in pts with syncope and known SSS. METHODS AND RESULTS: The effect of adenosine administration on the sinus and AVN was studied in a population consisted of 19 pts with clinical SSS (group SSS), 7 pts with syncope of unknown origin (group SUO), and 12 control subjects (group C). We calculated the maximum corrected sinus node recovery time (CSNRT), after overdrive pacing of the atrium at cycle lengths of 600, 500, and 400 ms and compared this value with the longest sinus pause, following adenosine administration corrected to the basic cycle length (ADSNRT). The longest R-R interval during atrioventricular block in response to adenosine injection (ADAVB) was also measured. Adenosine was given in a bolus dose of 0.15 mgr/kg through a femoral or large antecubital vein. There was a significant difference in the mean values of CSNRT among the three groups: group SSS (651 +/- 228 ms) > group SUO (284 +/- 100 ms) = group C (291 +/- 117 ms), F(2.35) = 19.078, P = 0.000. A significant difference was also found with ADSNRT: group SSS (5437 +/- 6863 ms) > group SUO (122 +/- 120 ms) = group C (801 +/- 1897 ms), F(2.35) = 4.513, P = 0.018. Using 525 ms as a cutoff value indicating sinus node dysfunction, CSNRT had a sensitivity of 74% and specificity of 100% for diagnosis of SSS while ADSNRT had 94% and 84%, respectively. Higher values of ADAVB in pts with SSS (10659 +/- 5872) and SUO (10026 +/- 7092) in comparison with controls (3615 +/- 5002) were measured, F(2.35) = 5.697, P = 0.007. No difference in the degree of ADAVB was found between the pts with SUO (10026 +/- 7092 ms) and syncope in the presence of SSS (12058 +/- 6787 ms), F(1.15) = 0.356, P = 0.56. CONCLUSION: Adenosine test appears to be at least comparable with CSNRT in making the diagnosis of SSS and may be considered as an alternative non-invasive test for confirmation of suspected SSS. No difference in the susceptibility of AVN to adenosine between the pts with syncope in the presence of SSS and those with unexplained syncope was found, suggesting that adenosine test cannot be used to diagnose atrioventricular block as the cause of syncope.     

Effect of amiodarone on sinus node function in patients with sick sinus syndrome

The effect of amiodarone on sinus node function has been studied in 9 patients with symptomatic sick sinus node as documented by Holter-ECG. All patients had programmable dual-chamber pacemakers. Sinus node activity was assessed by intermittently inhibiting the pacemakers before and after four weeks of oral amiodarone treatment. Sinus node function was not altered by amiodarone in 5 patients but was severely depressed in 4 patients. Thus, it is concluded that amiodarone cannot be used safely in all patients with the tachybrady syndrome for the treatment of symptomatic tachyarrhythmias without concomitant pacing.     

老年人病态窦房结综合征的电生理研究（附54例分析）

目的探讨病态窦房结综合征（病窦）的诊断方法、健康老年人窦房结的电生理多数值和老年人病窦的电生理诊断标准。方法对比分析３００例健康人、６１例老年可疑病窦患者及５４例老年病窦患者有关病窦诊断的各种电生理检查。结果健康人随增龄运动后最高心率达渐增高，阿托品试验后则下降；老年组阻滞后窦房结恢复时间及窦房传导时间延长，分别为１１１３±１５９及１０１±１６ｍｓ。老年可疑病窦组及病塞组阻滞后窦房结恢复时间延长，分别为１０３４±１６９及２０５０±８９ｍｓ，窦房传导时间亦延长，分别为１０７±１７及１９１±６９ｍｓ。结论阻滞后窦房结恢复时间延长是病窦的特异性改变，对诊断有重要意义。建议健康老年组阴滞后窦房结恢复时间以１１１３±５９ｍｓ为正常参考值，阻滞前≥１６５０ｍｓ及阻滞后≥１４５０ｍｓ或单纯阻滞后＞１４５０ｍｓ为老年人病窦电生理诊断标准。