老年严重缓慢性心律失常的临床分析

目的　探讨老年严重缓慢性心律失常的临床特征。方法　对 2 0 2例老年严重缓慢性心律失常患者的一般资料、心电图及动态心电图 ,心律失常的类型和治疗方法进行回顾分析。结果　①病态窦房结综合征 10 9例 (5 4 .0 % ) ,高度房室传导阻滞 5 2例 (2 5 .7% ) ,心房颤动伴长R R间歇 4 1例 (2 0 .3% ) ,晕厥 73例(36 .1% ) ,接近晕厥或黑 71例 (35 .2 % ) ,脑供血不足 5 8例 (2 8.7% )。②动态心电图长R R间歇 2 .1～ 9s ,平均 3.3s ;≥ 2s的长R R间歇 3～ 30 2次 /2 4h ;平均 4 1次 /2 4h ;合并快速房性和室性心律失常 71例(35 .2 % )。③均给予永久心脏起搏治疗 ,合用抗心律失常药物治疗 73例 (36 .1% )。结论　严重缓慢心律失常引起老年患者严重症状 ;动态心电图可更全面了解患者心律和心率 ,明确晕厥原因 ,便于临床合理选择治疗方法。永久心脏起搏合用抗心律失常药物是控制缓慢心律失常合并快速心律失常的有效方法。

Clinical analysis of severe bradyarrhythmia in elderly patients

Objective To study the clinical feature of severe bradyarrhythmias in the elderly patients.Methods Clinical data,electrocardiogram and dynamic electrocardiogram,classification of arrhythmia and therapy of 202 elderly cases with severe bradyarrhythmias were retrospectively analyzed.Results Of 202 cases with severe bradyarrhythmias,109 cases(54.0%) were with sick sinus syndrom,52 cases(25.7%) with high degree atrioventricular block and 41 cases(20.3%) of atrial fibrillation with long R-R interval.Syncope occurred in 73 cases (36.1%),near syncope in 71 cases (35.2%) and cerebral hypoperfusion in 58 cases(28.7%).Dynamic electrocardiogram was found with long R-R intervals with 2.1-9(average 3.3) seconds,long R-R intervals with more than 2 seconds appeared in 3-302(average 41) times/24h,and fast atrial or ventricular arrhythmias occurred in 71 cases(35.2%).Permanent cardiac pacing therapy was applied in all cases,and 73 cases(36.1%) accepted antiarrhythmial therapy.Conclusion Severe bradyarrhythmia usually leads to severe symptoms in the elderly patients.Dynamic electrocardiogram is very useful to distinguish the cause of syncope,to obtain the detail of heart rate and rhythm so that correct therapy can be selected.Permanent cardiac pacing combined with antiarrhythmia therapy is efficient in the treatment of bradycardia with tachyarrhythmias.