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.     

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…     

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。     

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…     

心内膜垫缺损与病态窦房结综合征

赵文萍住院医：患儿女、13岁,因＂心内膜垫缺损矫治术后11年,间断胸痛、胸闷1月余＂,以＂心内膜垫缺损矫治术后,病态窦房结综合征＂入院。     

病态窦房结综合征的病因诊断与预后

目的：探讨选择性冠状动脉造影对病态窦房结综合征（SSS）病因诊断的意义及不同治疗方式对SSS患预后的影响。方法：对61例在接受起搏器治疗后同时行选择性冠状动脉造影检查的SSS患随访并进行回顾性分析。结果：61例患中单纯高血压16例（26．2％）；高血压合并冠心病15例（24．6％），单纯冠心病5例（8．2％），不明原因25例（41．0％）。20例冠心病患中的12例（A组）接受起搏器＋经皮冠状动脉腔内成形术（PTCA）＋支架置入治疗，全部病例6个月后随访无再狭窄，心功能改善，但窦房结功能无改善；另外8例冠心病SSS患（B组）仅接受起搏器治疗而未行PTCA＋支架治疗，心功能的改善不及A组；41例非冠心病的SSS患（C组）仅接受起搏器治疗，心功能明显改善。结论：冠状动脉造影有助于SSS患的病因诊断，但冠心病并非SSS的主要病因；冠心病所致SSS患，DDD起搏器＋PTCA＋支架治疗是理想的治疗方法。     

病态窦房结综合征的功能检查价值评估及预后

目的：探讨病态窦房结综合征（ＳＳＳ）功能检查的价值及治疗方法对预后的影响。方法：９２例ＳＳＳ患者（其中随访６８例）按动态心电图表现分４型，分析功能检查（动态心电图、经食管心房调搏、阿托品试验、固有心率）对各型的临床意义。结果：动态心电图对发作期ＩＩ、ＩＩ、ＩＶ型具有诊断价值。黑或晕厥患者的长间歇时间（３．７７±１．４４秒）显著长于无症状或症状轻者（２．５８±０．３７秒）（Ｐ＜０．００１）；ＩＶ型出现黑或晕厥的发生率较其他各型高（Ｐ＜０．０１）；Ｉ型患者的窦房结恢复时间稍低于其他型（Ｐ＜０．０５）。固有心率测定较阿托品试验更可靠。结论：应根据ＳＳＳ各型特点有目的的选择功能检查。ＩＩ、ＩＶ型患者起搏治疗可减少猝死率。     

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。     

61例老年病态窦房结综合征动态心电图分析

动态心电图(DCG)作为病态窦房结综合征(SSS)非创伤检查手段之一，已被广泛接受，现报告如下。     

动态心电图对病态窦房结综合征的诊断及临床意义

目的探讨动态心电图（DCG）对病态窦房结综合征（SSS）的诊断价值。方法对300例住院窦性心动过缓者,进行DCG监测。结果显著窦性心动过缓（24h平均心率小于50次/分）者35例,窦房阻滞51例,窦性停搏28例,慢-快综合征46例,心房颤动、心房扑动伴房室阻滞者11例。结论 DCG对间歇性心率和心律改变的SSS者,能明显提高心律失常的检出率,是早期诊断SSS最可靠的方法 。     

Sick sinus syndrome

Sinus-node dysfunction is common in the elderly and, in most cases, does not cause any symptoms. Despite the high number of laboratory investigations, most diagnoses of sinus-node dysfunction are made by 12-lead electrocardiography, which shows severe sinus bradycardia, sinus arrest, or sinoatrial block. Continuous electrocardiographic monitoring, exercise testing, and electrophysiologic investigations (including pharmacologic interventions to cause complete autonomic blockade) are sometimes useful in detecting transient or latent sinus-node abnormalities. The term sick sinus syndrome should be reserved for patients with symptomatic sinus-node dysfunction. Sick sinus syndrome has a protean presentation with variable degrees of clinical severity. Symptoms are often intermittent, changeable, and unpredictable. Because these symptoms can be observed in several other diseases, none are specific to sick sinus syndrome. Owing to the nonspecific nature of its symptoms, sick sinus syndrome can be diagnosed only when clear electrocardiographic signs corroborate symptoms. In the absence of a demonstrable link between signs and symptoms, a diagnosis can be presumed only when signs of severe sinus dysfunction are present and when every other possible cause of symptoms has been excluded carefully. Sinus-node dysfunction frequently is associated with diseases of the autonomic nervous system, and autonomic reflexes play a major role in the genesis of syncope. Survival does not seem to be affected by sick sinus syndrome. Atrioventricular block, chronic atrial fibrillation, and systemic embolism are major pathologic conditions that affect the outcome of the syndrome. Treatment should be aimed at controlling morbidity and relieving symptoms. Cardiac pacing is the most powerful therapy; physiologic pacing (atrial or dual-chamber) has been shown definitively to be superior to ventricular pacing.     

Sick sinus syndrome in childhood.

The clinical and electrocardiographic findings in five children with the sick sinus syndrome and an otherwise normal heart are described. There were three boys and two girls. Their age at onset of either bradycardia or symptoms ranged from 1 day to 7 years. In one patient, the youngest ever reported with this syndrome, bradycardia was noted before birth. Four children presented with neurological symptoms--attacks of dizziness, fainting spells, or syncope. One boy, treated for epilepsy before the underlying arrhythmia ws diagnosed, died suddenly while playing. One child had near-fatal syncope caused by ventricular tachycardia. Continuous 24-hour electrocardiographic monitoring is the best method of assessing the severity of the condition. Sinus bradycardia, sinuatrial block, and periods of sinus arrest up to 4.8 seconds were recorded. Two patients had associated atrioventricular block and were therefore presumed to have binodal disease. Atrial fibrillation or flutter occurred in three patients. Isolated sick sinus syndrome may be a life-threatening condition in childhood for which, in selected cases, the insertion of a permanent pacemaker is indicated.     

Sick sinus syndrome due to cardiac amyloidosis

In a patient suffering from cardiac amyloidosis a case of sick sinus syndrome, manifested by markedly prolonged recovery time of the sinus node, was documented by an atrial pacing study. The first A-V junctional escape interval was markedly prolonged following the termination of the atrial pacing, pointing to a coexisting A-V nodal dysfunction. The patient required a permanent artificial pacemaker implantation.