健康人中Ⅰ度及Ⅱ度一型房室传导阻滞的病因及临床特点分析

目的研究健康人中Ⅰ度及Ⅱ度一型房室传导阻滞的病因、临床特点及预后。方法对2000~2011年常规心电图发现Ⅰ度及Ⅱ度一型房室传导阻滞、并经各项临床检查证实无器质性心脏病且年龄小于35岁者进行前瞻性研究,研究包括临床症状、心电图特点、房室结电生理特性,并对其中部分病例进行了随访。结果①共40例(男性28例,女性12例;年龄9~35岁,平均年龄26.2±7.9岁)进入本研究,其中仅表现为Ⅰ度房室传导阻滞者14例,兼有Ⅰ度及Ⅱ度文氏型房室传导阻滞者26例;房室传导阻滞均为间歇性发作。②28例无与房室传导阻滞相关的临床症状;12例有发作性胸闷,其中2例胸闷时心电图为PR过长(0.28 s),7例为Ⅱ度文氏型房室传导阻滞(其中6例伴窦缓),另3例未发现与胸闷相关的心电图异常。③38例进行了房室传导功能检查:38例基础状况下房室前传功能减退,使用阿托品后36例完全恢复正常,1例出现2∶1房室阻滞;38例中24例出现房室结双径路传导现象。④对25例进行3~10年的随访观察,未见有临床症状及房室传导阻滞加重的倾向。结论 25例的长期随访说明健康人Ⅰ度及Ⅱ度一型房室阻滞的预后良好。

The etiology and clinical characteristics of first - degree and type I second - degree atrioventricular block in healthy individuals.

Objective To study the etiology and clinical characteristics of first - degree and type I second - degree atrioventricular block （AVB） in healthy individuals. Methods Forty cases of first - degree AVB and/or type I second - degree AVB screened by routine electrocardiogram （ECG） between 2000 and 2011 were included in this study. All the cases were under 35 and had no organic heart disease. The clinical symptoms, ECG and electrophysiological properties of atrioventricular node were investigated. Results ①The mean age of 40 cases （ male 28, female 12 ） was 26.2 ± 7.9 years. Of 40 cases, 14 had first -degree AVB and others were second -degree AVB （type I） ; and all cases had intermittent AVB. ②28 cases were asymptomatic, 12 had chest distress. Of these 12 cases, 2 had a long PR interval （ 〉0.28 s）, 7 had second - degree AVB （type I） （6 had sinus bradycardia）, 3 had normal ECG. ③38 cases underwent cardiac electrophysiology study. Forward conduction function of atrioventricular decreased in 38 cases, after using atropine the function recovered to normal in 36 cases, but had 2 ： 1 AVB in one case. Dual A - V nodal pathways conduction phenomenon was found in 24 cases. ④25 cases were followed - up for 3 - 10 years, no evidence showed that there was a tendency toward aggravation of clinical symptoms and/or the degree of AVB. Conclusion Our long - term follow - up of 25 cases suggested that first - degree AVB and type I second - degree AVB could have a favour＇able prognosis in healthy individuals.