[SCD-FORUM] 14RE:心悸和心脏猝死危险－Makarov医师

[SCD Symposium]

14RE:心悸和心脏猝死危险－Makarov医师

亲爱的Vorotniak医师：

你提及了一个非常重要的问题：并发于心脏猝死高危 
危险疾病的临床综合征预后价值的评估。一般来说， 
二度或三度房室传导阻滞患者或者长QT和Brugada综合征 
患者发生的晕厥和心悸，具有致心律失常源性。此 
时，需要应用强效抗心律失常治疗（植入起搏器、抗 
心律失常药物等）。然而，经常发现房室传导阻滞患 
者植入起搏器后，仍继续晕厥发生，Holter未监测到心 
律失常。Brugada或长QT综合征患者发生血管迷走性晕厥 
的机率目前未深入研究。就“心悸”而言，值得一提 
的是所有类型患者中近16％表现此症状(Kroenke K et al.The  
prevalence of symptoms in medical outpatients and the adequacy of  
therapy. Arch Intern Med . 1990;150)，而且，心悸不完全因心 
律失常所致，1836年，J.C.Williams指出“心悸”常常被 
错误的认为等同于器质性心脏病。但事实并非如此， 
因为不管是正常情况还是发病过程中，神经系统的影 
响都具有重要作用。根据不同资料显示，35％到85％ 
的心悸患者中， 心电图记录正常。

1.     Baratta L, Maffe o N , Tubani L, Paradiso M, Molaioni C ,

Coppotelli L, Lagana B, Mastrocola C , Cordova C. Arrhythmias in the

aged : prevalence and correlation with symptoms]. Recenti Prog Med

1996 Mar;87(3):96–101.

2.     Goldberg AD, Raftery EB, Cashman PM. Ambulatory

electrocardiographic records in patients with transient cerebral

attacks or palpitation. Br Med J 1975 Dec 6;4(5996):569–71.

3.     Hashimoto T., Fucatani M., et al. Effects of stending on the

of Paroxysmal Supraventricular Tachycardia. JASS. — 1991. –Vol.  
17. –

N 3. — p. 650–695.

我们来自儿童人群中的数据显示，30％的“心悸”为 
非心律失常源性(Makarov et al, Pediatrics (Moscow) 2005;  
2:4-8)，而是由于心理因素或自主神经系统失调所致。 
因此，我们认为确认“心悸”为心律失常源性的“金 
标准”应该在发生或者促发相似的心律失常事件当 
时、并发相关症状时、运动负荷试验或经食道电刺激 
过程中进行记录。

就“心悸”的临床价值而言，短QT间期、Brugada综合 
征、致心律失常性右室功能不全或者短PR间期综合征 
患者，大数情况下，如果监测到心律失常（Holter监 
测、EPS或测力计），或者有其他高危因素（晕厥、心 
脏猝死家族背景、长QT综合征患者T波交替等），出现 
心悸症状则提示需要进行更强效的抗心律失常治疗。



Sergio Dubner博士

科委会主席

Edgardo Schapachnik博士

组委会主席

王玲洁译

14R RE: Palpitations and SCD risk. Dr. Makarov

Dear Dr. Vorotniak,

I think that you mentioned a very important issue: the evaluation of

the prognostic value of clinical symptoms, which may be concomitant

to diseases with high risk of SCD. In general, syncopes and

"palpitations" that occur in patients with 2nd or 3rd degree AV

block, and also in Long QT and Brugada syndromes, have arrhythmogenic

origin. For this reason, aggressive antiarrhythmic treatment

(implantation of pacemaker, antiarrhythmic drugs, etc.) is indicated.

However, it is often observed in patients with AV block, that after

pacemaker implantation, syncope episodes continue happening and no

arrhythmias are detected during Holter monitoring. The probability of

vasovagal syncopes in patients with Brugada and Long QT syndromes has

not been well studied yet. As to "palpitations", it is worth

mentioning that up to 16% of patients of all nosological groups may

present this symptom (Kroenke K et al.The prevalence of symptoms in

medical outpatients and the adequacy of therapy. Arch Intern Med .

1990;150). Moreover, "palpitations" do not always correspond to

arrhythmias. In year 1836, J.C. Williams mentioned that often times,

"palpitations" are mistakenly considered to be an equivalent of

structural heart diseases. But it is not so, because the influences

of the nervous system have a very important role, both in the normal

state and during some diseases. According to different data, in 35%

to 85% of the cases, "palpitations" are recorded in a normal ECG.

1.     Baratta L, Maffe o N , Tubani L, Paradiso M, Molaioni C ,

Coppotelli L, Lagana B, Mastrocola C , Cordova C. Arrhythmias in the

aged : prevalence and correlation with symptoms]. Recenti Prog Med

1996 Mar;87(3):96–101.

2.     Goldberg AD, Raftery EB, Cashman PM. Ambulatory

electrocardiographic records in patients with transient cerebral

attacks or palpitation. Br Med J 1975 Dec 6;4(5996):569–71.

3.     Hashimoto T., Fucatani M., et al. Effects of stending on the

of Paroxysmal Supraventricular Tachycardia. JASS. — 1991. –Vol.  
17. –

N 3. — p. 650–695.



Our data from the pediatric population show that 30% of

"palpitations" have a nonarrhythmogenic origin (Makarov et al,

Pediatrics (Moscow) 2005; 2:4-8) and they occur due to psychological

causes or autonomous nervous system disorders. Therefore, we assume

that the "gold standard" to confirm the arrhythmogenic origin of

"palpitations" would be to record them during the same episode, or

cause these arrhythmias, accompanied by the corresponding symptoms,

during ergometer test or transesophageal electrostimulation.

As to the clinical value of "palpitations" –in patients with short QT

interval, Brugada syndrome, arrhythmogenic RV dysplasia, or short PR

interval- this symptom may indicate the need for a more aggressive

antiarrhythmic treatment, mostly if arrhythmias are detected (in

Holter monitoring, EPS, ergometer) or if there are some additional

risk factors (syncopes, family background of SCD, T wave alternans in

patients with long QT syndrome, etc.)

Dr. Leonid Macarov

Institute of Pediatrics and Child Surgery (Moscow, Russia)

leo @oss.ru



--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee