直立倾斜试验阳性反应患者心律失常分析

目的探讨直立倾斜试验(HUTT)阳性反应患者心律失常发生的特点。方法对2000年9月至2005年7月在中南大学湘雅第二医院晕厥专科门诊就诊或住院的不明原因晕厥或接近晕厥患者进行HUTT检查(所有患者均签署知情同意书)。分析HUTT过程中心律失常发生情况。采用SPSS10.0统计软件进行统计学处理。结果127例HUTT阳性反应患者中122例(96.06%)患者出现心律失常。107例(84.25%)发生快速性心律失常,并在儿童及舌下含服硝酸甘油倾斜试验(SNHUT)中发生率高(P<0.01),无性别差异(P>0.05)。快速性心律失常以窦性心动过速(98.13%,105/107)多见,其中99例(94.29%)患者在心率达最快后5min内,平均(1.73±1.72)min发生阳性反应。58例(45.67%)患者发生缓慢性心律失常,窦性心动过缓多见(91.38%,53/58),常合并交界性逸搏心律、交界性逸搏和窦性停搏。10例窦性停搏患者平均停搏时间为(12.68±17.94)s。缓慢性心律失常患者基础心率偏慢,且在成人及基础直立倾斜试验(BHUT)过程中发生率高(P<0.05或P<0.01),而男女性别差异无显著性(P>0.05)。结论(1)HUTT过程中心率突然明显增快时应警惕阳性反应的发生。(2)缓慢性心律失常在成人及BHUT中发生率较高,常见类型有窦性心动过缓、窦性停搏、交界性逸搏心律、交界性逸搏等,发生缓慢性心律失常患者的基础心率偏慢。     

直立倾斜试验过程中的心律失常特点及安全性评价

目的探讨直立倾斜试验（HuTT）过程中的心律失常特点及安全性。方法对165例不明原因晕厥或接近晕厥患者首先进行基础直立倾斜试验（BHUT）,阴性患者再随机进行多阶段异丙肾上腺素倾斜试验（MIHUT）或舌下含化硝酸甘油倾斜试验（SNHUT）,分析HuTT过程中心律失常发生情况。结果快速性心律失常发生率50．91％（84／165）,92．68％窦性心动过速患者出现最快心率5min内发生阳性反应。缓慢性心律失常发生率30．91％（51／165）,最常见缓慢性心律失常依次为窦性心动过缓、交界性逸搏心律和窦性停搏,其中窦性停搏10例,停搏时间MIHUT组明显高于BHUT组和SNHUT组（P均〈O．01）。结论HUTT过程中心律失常发生率较高,心率突然明显增快时应警惕阳性反应发生。试验过程中存在长时间窦性停搏等多种安全风险,SNHUT在安全性等方面优于MIHUT。     

直立倾斜试验诊断晕厥的探讨

目的研究直立倾斜试验(HUTT)对血管迷走性晕厥(VVS)的诊断价值。方法入选2016年12月至2018年12月在本院就诊,不明原因晕厥,疑似VVS的患者124例,进行HUTT,包括基础倾斜试验(BHUT)和舌下含服硝酸甘油直立倾斜试验(SNHUT)。结果 124例受试者中,阴性反应57例,阳性反应66例,1例为体位性心动过速。阳性组的女性比例较高(p0.05);阳性组最快心率高于阴性组(p0.05),阳性组结束时的心率、收缩压、舒张压均低于最大值(p0.05),也明显低于阴性组(p0.05)。阳性反应中,BHUT就出现阳性反应的5例,占8%;SNHUT阳性61例,占92%;按反应类型:血管抑制性28例(42%),心脏抑制性9例(14%),混合型29例(44%)。3例受试者出现长RR间歇,最长达10.7s,2例受试者舌下含服硝酸甘油后出现腹痛不适。结论 HUTT对VVS具有较好的诊断价值,SNHUT能显著提高VVS的检出率。     

血管迷走性晕厥体位试验阳性反应儿童心律失常分析

目的探讨血管迷走性晕厥（VVS）儿童体位试验阳性者心律失常类型。方法分析63例体位试验阳性反应VVS儿童的心电图特征。结果 63例VVS体位试验阳性患儿中25例患儿发生心律失常,心律失常发生率为39.68%。心律失常类型为窦性心动过缓18例,交接性逸搏心律7例,二度房室阻滞5例,右束支阻滞2例,窦性停搏1例。结论 VVS患儿体位试验时常见缓慢性心律失常,其对体位试验阳性预测价值有待进一步研究。     

QTc间期缩短及临床意义的探讨

目的探讨QTc间期缩短的临床意义。方法分析7例QTc间期缩短患者的临床资料。结果除外甲状腺功能亢进(甲亢)及正常健康体检者的两次心电图均仅有QTc间期缩短,无恶性心律失常事件发生外,其余病例入院时心电图QTc间期正常,病情危重时急查心电图均示QTc间期缩短,伴窦性心动过缓、过缓交界逸搏心律1例,窦性停搏、室性逸搏心律1例,显著性窦性心动过缓1例,心房静止、窦室传导1例,窦性停搏,过缓室逸搏心律1例。且最终均出现过缓室性逸搏心律至全心停搏,经抢救无效死亡。结论 QTc间期缩短在不同临床背景下,可能有不同的表现和预后,在某些临床疾病情况下QTc间期缩短,往往是患者病情恶化征兆,预示心脏电活动衰竭,应引起临床高度重视。     

新生儿窦性心动过缓和窦性停搏引发交界性节律的心电特征

目的分析新生儿窦性心动过缓和窦性停搏引发交界性节律的心电特征。方法 6例新生儿,通过心电散点图逆向技术对时间RR间期(t-RR)散点图中振幅较高的散点逆向出片段心电图,诊断为交界性逸搏或/和交界性自主节律,分析散点图整体特征及心电动态变化规律。结果 6例患儿,年龄(11±2)天,心率(135±8)次/分,出现交界性心搏时的窦性心律性质为窦性心动过缓者2例,窦房传导阻滞者4例,窦性停搏者4例。24ht-RR散点图均为梳齿状,1ht-RR散点图呈λ形,Lorenz-RR散点图在45度线远端或者两侧呈稀疏散点分布。交界性心搏的RR间期变化。结论新生儿窦性心动过缓和窦性停搏引发交界性逸搏时t-RR散点图呈梳齿状或λ形,可反映心脏兴奋点的生理和病理节律变化特征。     

异丙肾上腺素诱发缓慢性心律失常一例

异丙肾上腺素倾斜试验时,阳性反应发生在体位倾斜之后。１例患者在平卧位静脉滴注异丙肾上腺素（ＩＳ）期间即发生与自然发作相似的表现,伴有窦性心动过缓、交界性逸搏心律及心室停搏。此种现象较为少见,报告如下,并对其发生机制进行讨论。患者女性,４０岁,因不明原...     

神经系统疾病

20040478舌下含化硝苯地平倾斜试验对血管迷走性晕厥的诊断价值/江顺银…刀临床荟萃一2003,18 (7)一361、363 检测患者组48例,正常对照组科例。患者组基础倾斜试验(BHUT)阳性12例,敏感性为25%,特异性为100%。对BHUT阴性者36例患者再进行舌下含化硝苯地平(10mg)倾斜试验(SNHUT)。结果:加做SNHUT后敏感性为69.4%,特异性为95.5%。不论BHUT阳性组,还是SNHUT阴性组,山平l冲位至HUT阳性时心率及平均动脉压均明显下降,SNHUT出现}‘日性时间较BHUT快。对照组SNHUT阳性率为0。SNHUT中,患者组仅2例,对照组仅1例出现头痛、面红等,…     

胺碘酮致交接性逸搏心律伴逆传双径路1例

患者女，65岁。因阵发性房颤入院。心脏超声提示肥厚性心肌病。临床诊断：肥厚性心肌病，心律失常。应用胺碘酮0．2g。一日3次。服至第6日出现心动过缓伴早搏。心电图表现如图1。停用胺碘酮后恢复为窦性心律。图1示除aVR、aVL导联外。余导联(包括未展出导联)窦性P波散在出现。甚至缺如。提示窦性心动过缓、窦房阻滞或窦性停搏。其余为房室交接性逸搏及逸搏心律。     

关于"呃逆、呕吐时频繁晕厥"的诊断思考

本病例主要的发病特点为:急性起病,反复呃逆、呕吐4d后出现晕厥。呃逆、呕吐伴晕厥为本病的突出表现。患者发生晕厥前有呃逆、呕吐,咳嗽后心率减慢,依次为窦性心动过缓、窦性停搏、交界性逸搏心率,安装临时起搏器后晕厥未再发生,但呃逆、呕吐仍有发生。呃逆、呕吐,咳嗽后见心率     

Mechanism of syncope in patients with positive adenosine triphosphate tests

OBJECTIVES: We prospectively evaluated the mechanism of syncope in patients with positive adenosine triphosphate (ATP) tests (defined as the induction of atrioventricular [AV] block with a ventricular pause >/=6 s after an intravenous bolus of 20 mg ATP). BACKGROUND: Patients with unexplained syncope tend to have more positive ATP tests results than those without syncope. METHODS: An implantable loop recorder (ILR) was inserted in 36 ATP-positive patients (69 +/- 10 years; 22 women; median of 6 syncopal episodes); 15 of them also had a positive response to tilt testing. RESULTS: During the follow-up of 18 +/- 9 months, 18 patients (50%) had syncopal recurrence and 16 (44%) had an electrocardiographically documented episode: AV block (n = 3: paroxysmal in 2 and permanent in 1), AV block followed by sinus arrest (n = 1), sinus arrest (n = 5), sinus bradycardia <40 beats/min (n = 2), normal sinus rhythm (n = 2), sinus tachycardia (n = 1), rapid atrial fibrillation (n = 1), and ectopic atrial tachycardia (n = 1). Bradycardia was documented in a total of 11 cases (69%), and a long ventricular pause (4 to 29 s) was present in eight cases (50%). All three patients with ILR-documented AV block had previously had a negative tilt test, whereas seven of eight with ILR-documented sinus bradycardia or sinus arrest had previously had a positive tilt test. CONCLUSIONS: In patients with adenosine-sensitive syncope, the mechanism of syncope is heterogeneous, although bradycardia is the most frequent finding. Adenosine triphosphate-induced AV block predicts AV block as the mechanism of spontaneous syncope in only a few tilt-negative patients.     

An implantable loop recorder study of highly symptomatic vasovagal patients: the heart rhythm observed during a spontaneous syncope is identical to the recurrent syncope but not correlated with the head-up tilt test or adenosine triphosphate test.

OBJECTIVES: The aim of this study was to analyze the heart rhythm during spontaneous vasovagal syncope (VVS) in highly symptomatic patients with implantable loop recorders (ILR) and to correlate this rhythm with the heart rhythm observed during head-up tilt test (HUT). BACKGROUND: Heart rhythm obtained during provocative condition is often used to guide therapy in VVS. To date there is no conclusive evidence that the heart rhythm observed during a positive HUT can predict heart rhythm during VVS or that the heart rhythm observed during a spontaneous syncope will be identical to the recurrent syncope. METHODS: Twenty-five consecutive VVS patients (age 60.2 +/- 17.1 years; 14 women,) presenting with frequent syncopes (6.9 +/- 4.6 episodes/year) and a positive HUT (cardioinhibitory in 8 patients) were implanted with an ILR. Seven of them also had a positive adenosine triphosphate (ATP) test. RESULTS: Follow-up was 17.0 +/- 3.6 months. Thirty VVS were observed in 12 patients. Nine episodes showed bradycardia of <40 beats/min or asystole; progressive sinus bradycardia preceding sinus arrest was the most frequent electrocardiographic finding. Twenty-one syncopes occurred without severe bradycardia. The heart rhythm observed during the first syncope was identical to the recurrence. No correlation was found between slow heart rate at the ILR interrogation and a cardioinhibitory HUT response (p = 1.0) or a positive ATP test (p = 1.0). CONCLUSIONS: In highly symptomatic patients with VVS, the heart rhythm observed during spontaneous syncope does not correlate with the HUT. The heart rhythm during the first spontaneous syncope is identical to the recurrent syncope.     

Autonomic and electrocardiographic changes in cardioinhibitory syncope.

AIMS: Cardioinhibitory syncope (CS) is a neurally mediated response causing bradycardia or asystole. This study reports on changes in blood pressure, heart rate variability (HRV), and ECG patterns before and after syncope with asystole. METHODS AND RESULTS: Thirty-five patients with CS and a matched control group were submitted to 60 degrees head-up tilt for 20 min with the addition of nitroglycerin. Syncope developed after a tilt-duration of 1.082 (range 50-1.734 s). Asystole lasted for 21.3 s (range 3.4-80.2 s) and was preceded by sinus rhythm in 21, junctional rhythm in 10, and atrioventricular block in four. Asystole was followed by sinus rhythm in four, junctional rhythm in 24, atrioventricular block in four, and atrial fibrillation in three. The two groups did not differ with respect to supine heart rate, HRV or blood pressure. Prior to syncope, patients showed significant increases in total and low-frequency HRV with reductions in high-frequency HRV and a progressive shortening of the PR-interval. CONCLUSION: Syncope was preceded by marked accentuation of sympathetic tone with a sudden shift in heart rate control to vagal dominance. Asystole was accompanied by vagally induced, benign arrhythmia in the majority of the patients.     

Head-Up Tilt Test (HUTT) in Patients with Episodic Bradycardia and Hypotension Following Percutaneous Coronary Interventions

We investigated the possible association of post catheterization hypotension/bradycardia and neurocardiogenic syncope. Head up tilt test (HUTT) was performed in 12 consecutive patients (age 32D65 years) who developed transient hypotension (systolic blood pressure < 80 mmHg) and/or bradycardia (heart rate < 50/min) with or without syncope following a percutaneous coronary intervention. Ten patients had undergone percutaneous transluminal coronary angioplasty (PTCA) with stent implantation and one each PTCA alone and diagnostic coronary angiography. This event occurred at the time of sheath removal in 7 patients (58%). HUTT was performed with and without intravenous edrophonium (10 mg intravenous). The tilt test was negative in all patients. Post-catheterization hypotension/bradycardia responds promptly to conservative measures and it is unclear whether this is related to neurocardiogenic syncope.     

Three cases of single coronary artery

Single coronary artery has been considered a minor coronary anomaly without clinical importance. With the wide spread of coronary angiography, however, the disease has been reported to develop complications at a high rate, such as angina, myocardial infarction and arrhythmia. We report three patients with single coronary artery with several complications. Case 1: A 56-year-old woman having a past history of diabetes mellitus and myocardial infarction was admitted because of the recently developed frequent attacks of effort angina. Treadmill test was positive and thallium-201 exercise myocardial scintigraphy revealed redistribution in the lateral wall. Ascending aortogram suggested that the right coronary artery (RCA) arose from the left sinus of Valsalva. An injection into the right sinus of Valsalva revealed no coronary ostium. Selective left coronary angiogram resulted in the diagnosis of single coronary artery (Smith's type 2) with 90% stenosis in the left circumflex artery (LCX). Left ventriculogram showed hypokinesis in the anterolateral wall. PTCA performed on this patient revealed clinical and nucleomedical improvement. Case 2: A 48-year-old man experienced chest pain and syncope. Electrocardiogram revealed ST-elevations in II, I and a VF, sinus bradycardia and atrioventricular junctional rhythm. Angiography resulted in the diagnosis of single coronary artery (Smith's type 2) with 75% stenosis in the RCA. Ergonovine test was positive. Case 3: A 69-year-old man complained of chest pain. Electrocardiogram showed complete right bundle branch block, sinus bradycardia and atrioventricular junctional rhythm. Cardiac catheterization revealed that this was also a case of single coronary artery (Smith's type 2) with no significant stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

倾斜试验对血管迷走性晕厥的诊断及分型

目的 探讨倾斜试验对血管迷走性晕厥的诊断及分型的意义。方法 ８０例不明原因晕厥患者为病人组,４７例无晕厥病史的健康人作为对照组均采用此试验,包括基础倾斜试验和异丙肾倾斜试验。结果 （１）不明是性主（７６．２５％）明显高于对照组（２９．７９％）,异丙肾滴注后,试验阳性率明显增加,假阳性率相应增加。（２）试验阳性者晕即刻民基础血压比较差异有显著性,而心率比较差异无显著性。（３）在所有试验阳性者中,血管     

Utility of transesophageal atrial pacing in the diagnostic evaluation of patients with unexplained syncope associated or not with palpitations

BACKGROUND: Noninvasive studies are often negative in patients with syncope, normal surface ECG and without heart disease. The purpose of the study was to determine the diagnostic impact of an esophageal electrophysiological study performed during a consultation. METHODS: A total of 154 patients aged from 16 to 87 years were consecutively recruited for unexplained syncope; they had a normal ECG in sinus rhythm, no documented arrhythmia and no patent heart disease. Half of them complained of palpitations. Electrophysiologic study was performed during a consultation by transesophageal route: rate of 2nd d AV block occurrence during atrial pacing and sinus node recovery time were determined; programmed atrial stimulation using one and two atrial extrastimuli were delivered in control state and then after infusion of 0.02-1 microg/min of isoproterenol; arterial blood pressure was monitored. RESULTS: (1) Electrophysiologic study was positive in 107 patients (69%); (2) sinus node dysfunction was noted in 9 patients (6%); (3) atrioventricular conduction disturbances were noted in 2 patients (1%); (4) vasovagal reaction which associated a junctional bradycardia and a fall of arterial blood pressure and which reproduced spontaneous symptoms was provoked by isoproterenol infusion in 21 patients (14%); (5) sustained atrial fibrillation was induced in 23 patients (15%); and (6) paroxysmal junctional tachycardia was induced in 52 patients (34%). Patients with negative study were younger (44+/-21.5 years) than those with sinus node dysfunction or atrial fibrillation (71+/-9 and 63+/-14 years, respectively). The treatment was guided by these data: patients with inducible atrial fibrillation were treated by antiarrhythmic drugs and those with inducible paroxysmal junctional tachycardia by the radiofrequency ablation of reentrant circuit. Syncope disappeared in all patients but 2. CONCLUSION: Esophageal electrophysiologic study performed during a consultation was a safe, rapid and economic means to detect an arrhythmia (sinus node dysfunction or supraventricular tachycardia) in patients with dizziness/syncope and palpitations in half cases. Supraventricular tachycardia was clearly an underestimated cause of syncope in this population.     

Significance of tilt table testing in patients with suspected arrhythmic syncope and negative electrophysiologic study

BACKGROUND: The diagnostic significance of a tilt table test (TTT) in patients with a suspected arrhythmic etiology for syncope and negative electrophysiologic study (EPS) has not been previously assessed comparing the TTT results with the findings of prolonged monitoring using an implantable loop recorder (ILR). We sought to assess the diagnostic yielding of TTT in patients with suspected arrhythmic syncope and negative EPS. METHODS AND RESULTS: In 81 patients with suspected arrhythmic etiology for syncope and negative EPS, TTT was performed and an ILR implanted regardless the results of TTT. TTT was positive in 38 patients. During follow-up, syncope or presyncope recurred in 32 patients (39.5%). No differences were found in recurrence rates in patients with positive and negative TTT (31.5% vs 46.5%, P = ns). According to rhythm registered during ILR activation, mechanisms of syncopal events were classified as: arrhythmic (atrioventricular [AV] block and ventricular tachycardia; n = 18), neurally mediated (sinus bradycardia and sinus pause; n = 9), and indeterminate (normal sinus rhythm; n = 5). There was no statistical association between the results of TTT and the mechanism of syncope. CONCLUSIONS: In patients with a suspected arrhythmic etiology for syncope and a negative EPS, TTT is of little value to predict the mechanism of syncope and the ILR implantation seems to be a useful and safe diagnostic strategy.