Incidence, Clinical Presentation and Outcome in Patients with Long Asystole Induced by Head-up Tilt Test

傾斜床試驗所致長的心跳停止病患之發生率臨床表現及結果

周銘霆(Ming-Ting Chou) ； 鄭成泉(Chen-Chuan Cheng) ； 吳文憲(Wen-Shiann Wu) ； 黃崔源(Tseui-Yuen Huang)

《內科學誌》 16卷3期 (2005/06) Pp. 134-138

https://doi.org/10.6314/JIMT.2005.16(3).05

摘要

長的心跳停止發生於傾斜床試驗並不常見。若停止時間超過五秒就被稱爲“惡性”。雖然近來一些報告顯示此一現象預後多爲良性，但大多數的報告多來自西方國家，種族的差異是有可能的。所以我們於此呈現這類病患的資料。604位不明原因暈厥接受傾斜床試驗。其中包括30分鐘被動傾斜床試驗及30分鐘注射Isoproterenol使基本心跳至少上升20%。反應的型態皆加以分析及歸類並尋找有長的心跳停止者而於2004年十月於門診或電話做追蹤。242位病人(40.1%)爲陽性反應，其中172位(71.1%)爲混合型，60位(24.8%)爲血壓下降型，而僅有10位(4.1%)爲心跳抑制型。三位(1.2%)病人有長的心跳停止，包括一位年輕女性及二位有心房顫動之年長男性。年輕女性先接受midodrine治療，停藥後很少再復發，而兩位年長者則接受永久性心律節律器置放且再沒有暈厥發生。傾斜床試驗所致長的心跳停止於我們的病人發生機率比西方國家所報告低了許多。針對有心房顫動之年長男性發生不明原因暈厥時，傾斜床試驗或許可以做爲輔助之診斷工具。

並列摘要

Long asystole during head-up tilt test is uncommon. When the duration is more then 5 seconds, it has been called malignant. Although recent reports have demonstrated long asystole response is quite a benign course. Owing to most of these reports came from western countries, ethnic variation is possible. The clinical data about this subset of patients are reported herein. Head-up tilt test was employed for 604 patients with syncope of unknown origin. The protocol included 30min passive tilt test and 30min isoproterenol infusion which increased the heart rate up to 20% from baseline. The response patterns were analyzed and categorized. The prolonged asystole was searched. Follow up was made at the outpatient clinic or by phone during October 2004. Two hundred forty-two patients (40.1%) had positive response. 172 patients (71.1%) with the mixed type, 60 patients (24.8%) with the vasodepressive type and only 10 patients (4.1%) with the cardioinhibitory type. Three patients (1.2%) had prolonged asystole. One young girl and two elderly males with atrial fibrillation. The young girl received midodrine treatment and stop the medication 6 months later with only few recurrence of syncope. The two elderly received pacemaker implantation without syncope recurrence. The incidence of long asystole during head-up tilt test in our patients was much lower than that of western countries. Head-up tilt test may be an helpful tool for evaluation of syncope in elderly patients with atrial fibrillation.

並列關鍵字

Head-up tilt test ； Long asystole ； Syncope