上海交通大学学报（医学版）

›› 2010, Vol. 30 ›› Issue (3): 360-.

• 病例报告 • 上一篇    下一篇

频率骤降反应起搏器治疗血管迷走性晕厥二例报道

吴志俊, 陈 颖, 严鹏勇, 吴立群   

  1. 上海交通大学 医学院瑞金医院心脏科, 上海 200025
  • 出版日期:2010-03-25 发布日期:2010-03-24
  • 通讯作者: 吴立群, 电子信箱: wuliqun89@hotmail.com。
  • 作者简介:吴志俊（1982—）, 女, 住院医师；电子信箱: totito19822005@yahoo.com.cn。

Two cases report of vasovagal syncope treated by rate drop response function pacemaker

WU Zhi-jun, CHEN Ying, YAN Peng-yong, WU Li-qun   

  1. Department of Cardiology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
  • Online:2010-03-25 Published:2010-03-24

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摘要：

血管迷走性晕厥（VVS）是一种神经心源性晕厥，其中心脏抑制型和混合型均伴有心率骤降，起搏介入治疗可能有效。文章报道采用频率骤降反应起搏器对2例反复发作VVS患者的治疗情况。患者发作前有头晕、心悸等先兆症状，发作时伴抽搐、尿失禁；心电图及24 h动态心电图未见特征性改变；直立倾斜试验阳性和阴性各1例。患者植入双腔起搏器（DDDR）后开启频率骤降功能。术后随访有频繁抗频率骤降起搏介入，患者症状改善，未出现晕厥。具有频率骤降反应、频率平稳、感知dp/dt的频率反应起搏治疗VVS较单纯药物治疗的优势明显，但起搏介入模式和参数应根据个体特点设置，需定期随访进行调整和优化。

关键词: 血管迷走性晕厥, 直立倾斜试验, 起搏器, 频率骤降

Abstract:

Vasovagal syncope (VVS) is a neurocardiogenic syncope. Cardioinhibitory pattern VVS and mixed pattern VVS are complicated with heart rate drop, and may be treated by pacing intervention. The management of two patients with frequent VVS by rate drop response function pacemaker was reported in this paper. Patients experienced intermittent dizziness and palpitation at episode, followed by convulsion and urinary incontinence.There were no specific changes on routine electrocardiogram and 24 h ambulatory electrocardiogram, and tilt table tests were positive in one patient and negative in the other. Patients underwent implantation of dual chamber pacemaker (DDDR) with rate drop response function. There was frequent pacing intervention combating rate drop during follow up after implantation, and the symptoms were improved, with no incidence of syncope. Rate drop response function pacemaker enjoys significant advantages over drug therapy in management of VVS. However, programming and parameters of pacemaker need to be optimized individually and periodically according to clinical findings.

Key words: vasovagal syncope, tilt table test, pacemaker, rate drop response