经食管心房起搏对心脏抑制型血管迷走性晕厥作用的探讨

为评价心脏起搏对心脏抑制型血管迷走性晕厥（ＣＩＶＶＳ）的作用，对２５例首次倾斜试验（ＨＵＴ）阳性并表现为ＣＩＶＶＳ的病人行重复ＨＵＴ，当病人出现心动过缓时，以７２ｂｐｍ的频率经食管心房起搏（ＴＥＡＰ）。２５例中有１８例病人出现心率减慢，其中１例在起搏前即出现晕厥伴低血压；另１７例行ＴＥＡＰ，２例出现房室阻滞伴晕厥，１５例起搏心率维持在７２ｂｐｍ，但起搏７．３７±４．３０（４～１８）ｓ后，病人出现晕厥或先兆晕厥，平均动脉压由８８．８８±１０．０８ｍｍＨｇ降至５５．８６±１２．１８ｍｍＨｇ（Ｐ＜０．０１）。提示ＴＥＡＰ不能预防ＣＩＶＶＳ晕厥的发生。

The Role of Atrial Pacing for the Treatment of Cardioinhibitory Vasovagal Syncope

To evaluate the efficacy of cardiac pacing in patients with cardioinhibitory vasovagal syncope(CIVVS),twentyfive patients who diagnosed as CIVVS by the first HUT(headup tilt testing) were carried out the second HUT.When bradycardia(heart rate < 60 beats per minute) occurred during the second HUT,transesophageal atrial pacing(TEAP) at 72 beats per minute was initiated.Results:Eighteen of twentyfive patients had bradycardia during second HUT.One of them had syncope and hypotension before TEAP.The other seventeen patients were undertaken TEAP.Two of seventeen patients had presyncope and hypotension with atrioventricular block during pacing.The mean arterial pressure of the other fifteen patients decreased abruptly from 88.810.08 mmHg to 55.8612.18 mmHg(P<0.01) though heart rate maintained 72 beats per minute by TEAP,leading to syncope or presyncope.Conclusion:TEAP is ineffective for CIVVS.