Intermittent Complete Atrioventricular Block with Syncope: A Case Report

間歇性房室傳導完全阻斷伴隨暈厥：病例報告

蔡適吉(Su-Kiat Chua) ； 駱惠銘(Huey-Ming Lo)

《中華民國急救加護醫學會雜誌》 17卷4期 (2006/12) Pp. 175-180

https://doi.org/10.30018/JECCM.200612.0006

摘要

暈厥是一種常見的急症，約佔急診原因的3%。其病因甚為複雜，而且絕大多數屬陣發性，因此要確切診斷暈厥的病因對醫師而言是一大挑戰。本文報告一位反覆暈厥發作的71歲男性病人。除了心電圖顯示二支束傳導阻斷外，其他基本的檢查（包括廿四小時心電圖紀錄、心臟超音波、腦部電腦斷層、腦波、穿透頭顱骨都卜勒超音波、及傾斜台檢查）都是正常的。重覆第二次的廿四小時心電圖檢查才發現間歇性房室傳導完全阻斷，最久的心跳停止時間長達19.4秒。病患當時正坐著看電視，感覺兩眼發黑以及胸悶。此病患在接受永久性心律調節器植入術後其症狀就完全改善了。

關鍵字

二支束傳導阻斷 ； 房室傳導完全阻斷 ； 暈厥 ； 廿四小時心電圖

並列摘要

Syncope is a common emergency condition, which accounts for 3% of emergency room visits. The etiology of syncope is complicated and most of the presentation is paroxysmal. Thus, it is extremely challenging for the physicians to establish the cause of syncope. A 71-year-old man with recurrent of attack syncopeis reported here. In his initial presentation, all basic studies including 24 hours ambulatory electrocardiogram (ECG) monitoring, echocardiography, brain computed tomographic (CT), electroencephalogram (EEG), transcranial duplex imaging and tilt table test, were negative except ECG found bifascicular block. At a subsequent syncopal attack, 24 hours ambulatory ECG was repeated and found intermittent complete atrioventricular block with prolonged ventricular asystole up to 19.4 sec. The patient recalled black out of bilateral vision and chest tightness when he was sitting and watching TV at this period. He received a VDD pacemaker implantation and became symptom free during the follow up period.

並列關鍵字

bifascicular block ； complete AV block ； syncope ； 24 hours ambulatory ECG