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題名 | Late Development of Persistent Atrial Fibrillation with Loss of AAI Mode Pacemaker Function and Superior Vena Cava Syndrome--Report of a Case of Sick Sinus Syndrome with Such Complications and Review of Literature=心房需要型心律調節器經靜脈置放在病竇症病人晚期併發持續性心房顫動及上腔靜脈阻塞--一病例報告及文獻回顧 |
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作者 | 張興亞; 江志桓; 蕭相江; 丁予安; Chang, Hsing-ya; Kong, Chi-woon; Hsiao, Hsiang-chiang; Ding, Philip Yu-an; |
期刊 | Acta Cardiologica Sinica |
出版日期 | 19990400 |
卷期 | 15:2 1999.04[民88.04] |
頁次 | 頁93-98 |
分類號 | 415.318 |
語文 | eng |
關鍵詞 | 心律調節器; 心房需要型; 心房顫動; 上腔靜脈阻塞症候群; Pacemaker; AAI; Atrial fibrillation; Superior vena cava syndrome; |
中文摘要 | 經靜脈置放之永久性心律調節器引發上腔靜脈阻塞是罕見的併發症,其臨床表現 可以從沒有症狀到對生命構成威脅。心房需要型心律調節器是裝置於病竇症病人的首選,但 心房顫動是潛在不可預期的主要臨床問題之一。本文報告一病例同時合併此兩種狀況,並且 回顧文獻綜合討論。本文報告一位 77 歲男,性病患出現暈厥,經二十四小時心電圖及心電 生理檢查確定為病竇症。因房室傳導檢查正常,心房需要型心律調節器被選用經靜脈植入。 術後 39 個月,病人出現持續性心房顫動及心跳暫停過長。在重新更換調節器型式時,靜脈 攝影顯示上腔靜脈完全阻塞。於是改用心外膜心律調節器,並使用抗凝血劑,經數月後病人 的症狀得到完全解除。心房需要型心律調節器被認為是用於病竇症且合併正常房室傳導病人 的最佳選擇,但潛在未來發展成持續性心房顫動而造成調節器功能失效。若是用雙腔型調節 器調整成心房需要型或者使用較長的房室傳導間距,可作為理想的取代方式,並同時保有心 室需要型的功能做後盾。經靜脈植入心律調節器引發上腔靜脈阻塞是少見但被確認的併發症 ,最佳的治療方式是根據病人的臨床表現而定。 |
英文摘要 | Superior vena cava (SVC) syndrome is a rare complication of transvenous permanent pacing. Its clinical manifestations may vary from asymptomatic to lifethreatening. In patients with sick sinus syndrome(SSS), AAI pacing is considered the optimal mode, but potential occurrence of persistent atrial fibrillation with loss of pacemaker function in later life is unpredictable. We encountered a case of SSS who developed both of these complications after an AAI mode implantation. The patient was a 77-year-old man, presenting with occasional dizziness and presyncope. Sick sinus syndrome was documented by Holter ECG and electrophysiologic study. An AAI pacemaker was implanted due to normal atrial-ventricular (AV) conduction. Symptoms recurred because of persistent atrial fibrillation with long pauses. On changing the mode of the pacemaker, a phlebogram revealed complete obstruction of the SVC. A new VVI pacemaker with an epicardial lead was implanted, and the patient was put on anticoagulant therapy. The patient's symptoms improved thereafter. In SSS, AAI pacing is considered to be the optimal mode of pacemaker therapy. However, persistent atrial fibrillation with loss of pacemaker function may occur in later life. A dual chamber unit programmed to AAI mode or with a long AV delay could be an ideal alternative and retain the benefits of ventricular pacing backup. SVC syndrome is a well-recognized but rare complication of transvenous permanent pacing. Optimal treatment depends on the underlying condition and clinical manifestations. |
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