Syncope in Patients with Pacemakers
Syncope in Patients with Pacemakers
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DOI：
10.15420/aer.2015.4.3.189
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发表时间：
2015-12-01
影响因子：
3
通讯作者：
Sutton, Richard
中科院分区：
文献类型：
--
作者：
Sutton, Richard
心脏起搏器患者的晕厥是一种严重的症状，但很少是由于心脏起搏器系统故障。在5年内，约5%的房室（AV）传导阻滞起搏患者发生晕厥，10年内，18%的窦房结疾病起搏患者发生晕厥，20%的颈动脉窦综合征起搏患者发生晕厥，5- 55%的老年血管迷走性晕厥起搏患者发生晕厥。血管迷走性晕厥的结果差异很大，这取决于倾斜试验的结果。倾斜试验阴性者的起搏结果接近房室传导阻滞，倾斜试验阳性者的结果并不比没有起搏器的结果好。倾斜结果的含义是，倾斜阳性明确表明晕厥复发伴低血压。这个问题可以通过在适合的患者中使用血管收缩药物治疗来解决，或者更常见的是，减少或停止高血压患者的血管收缩治疗。晕厥的其他原因，如快速性心律失常是罕见的。详细介绍了报告晕厥患者的临床方法。
Syncope in a pacemaker patient is a serious symptom but it is rarely due a pacemaker system malfunction. Syncope occurs in about 5 % of patients paced for atrioventricular (AV) block in 5 years, 18% in those paced for sinus node disease in 10 years, 20 % of those paced for carotid sinus syndrome in 5 years and 5-55 % of those older patients paced for vasovagal syncope in 2 years. The vastly different results in vasovagal syncope depend on the results of tilt testing, where those with negative tests approach results in pacing for AV block and those with a positive tilt test show no better results than with no pacemaker. The implication of tilt results is that a hypotensive tendency is clearly demonstrated by tilt positivity pointing to syncope recurrence with hypotension. This problem may be addressed by treatment with vasoconstrictor drugs in those who are suited or, more commonly, a reduction or cessation of hypotensive therapy in hypertensive patients. Other causes of syncope such as tachyarrhythmias are rare. The clinical approach to patients who report syncope is detailed.