陣發性上心室頻脈

Paroxysmal Supraventricular Tachycardia

賴淩平(Ling-Ping Lai)

《中華民國急救加護醫學會雜誌》 10卷4期 (1999/12) Pp. 139-143

https://doi.org/10.30018/JECCM.199912.0001

摘要

陣發性上心室頻脈（paroxysmal supraventricular tachycardia，簡稱PSVT）為急症中常見之診斷，病患最常見之症狀為突然發生之心悸，常伴隨其他全身性之症狀，包括頭暈，全身無力，盜汗，呼吸困難，胸悶等。心電圖典型之表現為快速但現則之QRS波，其速度約在每分鐘一百五十到兩百五十次之間。陣發性上心室頻脈最常見的機轉為房室結迴路頻脈(atrioventricularnodal reentrant tachycardia)及房室往復式頻脈(atrioventricular reciprocating tachycardia)，這兩者佔了90％以上，其他還有心房頻脈(atrial tachycardia), 心房撲動(a trial flutter)，但是較為少見。在急性處置上，對於血行動力不穩定的病人可以考慮電擊，一般建議之電擊能量為50~100焦爾，對於穩定的病人，我們建議先作標準十二導程心電圖，再替病人裝上心電圖監視器，然後實施頸動脈竇之按摩(carotid massage)。如果頸動脈竇按摩無效，則可考慮藥物治療，目前首選之藥物應為adenosine，其他藥物如verapamil, diltezam之靜脈注射也常用來治療陣發性上心室頻脈。近年來對陣發性上心室頻脈的治療上有突破性進展，經導管電氣燒灼術可以消滅心臟中之迴路，而使陣發性上心室頻脈得到根治，終生不再復發，而由於經導管電氣燒灼術的進展，也使我們對陣發性上心室頻脈的電生理機轉有更進一步的瞭解。

關鍵字

陣發性上心室頻脈 ； 經導管電氣燒灼術

並列摘要

Paroxysmal supraventricular tachycardia (PSVT) is a distinct clinical syndrome. Most patients present with the abrupt onset of palpitations, dizziness, dyspnea, or chest pain. The electrocardiogram demonstrates a fast heart rate (150-250 beats per mm), a regular rhythm, and most often, narrow QRS complexes. The P wave is usually hidden within the QRS complex or T wave. PSVT is usually caused by reentry. The most common two electrophysiological mechanisms of PSVT are atrioventricular nodal reentrant tachycardia and atrioventricular reciprocating tachycardia. For the acute management of PS VT, unstable patients require emergent electrical cardioversion. Valsalva maneuver may be attempted in stable patients. If the maneuver is not effective, adenosine is the first-line agent to treat PSVT in most patients. For definite treatment, radiofrequency catheter ablation has been proved to be highly effective. The PSVT can be eradicated with minimal side effects.

並列關鍵字

paroxysmal supraventricular tachycardia(PSVT) ； radiofrequency catheter ablation