発作性房室ブロックの臨床的並びに電気生理学的検討
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Paroxysmal atrio-ventricular block (PAVB) is known to be one of the most important mechanisms by which Adams-Stokes syndrome is precipitated. To evaluate the pathophysiology of PAVB, clinical and electrophysiological studies were performed in 23 electrocardiographically documented patients (pts). These cases were divided into 3 groups according to the site of the block: supra-His (AH) group, 6 pts; intra-His (HH') group, 8 pts; and infra-His (HV) group, 9 pts. The 12-lead electrocardiogram (ECG) was normal or slightly abnormal in 12 pts (52.5%). Atrioventricular block (AVB) and intraventricular conduction disturbance were more frequent in the HH' and HV groups than in the AH group (p<0.05). ECG monitoring also showed transient second degree AVB in 4/6 of the AH, 8/8 of the HH' and 8/9 of the HV groups. PAVB was initiated by slowing of the atrial rate in 5/6 of the AH group, but by rate increase or a premature atrial contraction in 16/17 of the HH' and HV groups. The duration of ventricular standstill was longer in the HH' or HV groups (7.6±3.2sec.) than in the AH (4.7±1.4sec) group. Ventricular escape terminated PAVB in 5/8 of the HH' and 5/9 of the HV groups. The administration of positive chronotropic agents such as atropine and isoproternol caused PAVB or syncope in 4 pts, 2 pts each from the HH' and HV groups. Implantation of an artificial pacemaker was needed to prevent Adams-Stokes syndrome in all cases. In the electrophysiological studies, rapid atrial pacing was able to reveal PAVB within the critical zone of the pacing rate (PAVB zone) in 7/16 (43.8%) pts, who were mostly those of the HH' or HV groups whose spontaneous attacks were preceded by an increase of the atrial rate. These results suggest that PAVB occurs according to different mechanisms depending on the site of the block. In the HH' and HV groups PAVB was initiated by an increase of the atrial rate not only in ?spontaneous episodes but also in the electrophysiological study. Repetitive concealed conduction might play a role in the initiation of PAVB in HH' and HV groups.
- 札幌医科大学の論文
- 1989-04-01
札幌医科大学 | 論文
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