房室间期自动搜索功能对心室起搏及心功能的影响

目的 观察自动AV间期搜索功能双腔起搏器减少心室起搏和高频心房事件的效果及对心功能的影响.方法 60例置入DDD/R起搏器的患者（有AV搜索功能30例,无AV搜索功能30例）,术后1年内程控获取右室起搏百分比、高频心房事件,检查超声心动图,测试血浆利钠肽（BNP）值.结果 有AV搜索功能组术后6个月和12个月右室起搏百分比明显小于无AV搜索功能组[（21.2±6.0）％比（78.3±7.5）％,（19.1±6.5）％比（73.4±7.9）％,P均＜0.05）.AV搜索功能组左室射血分数、左室Tei指数均明显改善（0.57±0.03比0.53±0.05,0.48±0.15比0.68±0.20,P均＜0.05）;BNP水平明显降低[（75.2±34.5）pg/ml）比（37.0±16.4）pg/ml,P＜0.05];高频心房事件也显著减少[（42±10）次比（19±11）次,P＜0.05].结论 AV自动搜索功能起搏器可有效减少不必要的右室起搏及高频心房事件,改善血流动力学效应.     

双腔起搏器自动房室间期搜索功能的临床应用观察

目的观察双腔起搏器自动AV间期搜索功能(auto AV search)减少心室起搏的有效性及对心功能和快速房性心律失常的影响。方法43例植入具有自动AV间期搜索功能的双腔DDD(R)起搏器的患者,术后6个月内随机交叉关闭或打开AV search功能各3个月,分别在第一阶段(3个月末)、第二阶段(6个月末)程控获取心室起搏百分比(Vp)、高频心房事件及测试血浆BNP值。结果43例患者按计划完成随访,AV search关闭组心室起搏(VP)比例为78.0±10.3%,心房高频事件为58±15次,血浆脑钠肽(BNP)水平为333±30pg/ml;AVsearch打开组Vp比例为15.9±4.8%,心房高频事件为29±13次,BNP65±21 pg/ml,两者相比具有显著统计学差异(P<0.01)。结论双腔起搏器的auto AV search功能可有效减少非必须的心室起搏,促进自身心室激动。     

双腔起搏器自动房室间期搜索功能的临床随访观察

目的 观察双腔起搏器自动房室间期搜索功能(AV Search)减少心室起搏的有效性及对血流动力学和快速房性心律失常的影响.方法 对两种DDD/R起搏器97例(有AV Search功能47例,无AV Search功能50例)患者术后半年内随访观察.结果 有AV Search功能组术后1、3、6个月右心室起搏百分比明显小于无AV Search功能组[(19.2±5.6)%vs(80.4±10.2)%,(17.8±6.6)%vs(75.3±9.5)%,(17.4±7.3)%VS[76.2±8.6]%,P<0.05].有AV Search功能组心脏指数、每搏量、左心室舒张末内径、左心房内径及患者心功能分级均无明显改善(P>0.05);而左心窒射血分数则高于无AV Search功能组(P<0.05).高频心房事件也显著减少((31±9)vs(49±11),P<0.05].结论 有AV Search功能DDD/R双腔起搏器在减少非必须的心室起搏,改善血流动力学,减少高频心房事件方面优于与无AV Search功能DDD/R起搏器.     

具有自动房室间期搜索功能的双腔起搏器的临床随访

目的: 观察具有自动房室(AV)间期搜索功能的双腔起搏器减少心室起搏的有效性及起搏器长期的参数变化及安全性。方法: 对两种DDD/R起搏器86例(有搜索功能40例,无搜索功能46例)患者术后半年内随访观察。结果: 有搜索功能组术后1、3、6个月右室起搏率明显小于无搜索功能组［(20±6)% vs. (78±12)%,(18±7)% vs. (73±9)%,(19±5)% vs. (76±9),均P<0.05］。两组起搏参数及患者心功能分级均无明显差异。随访期间未出现AV搜索功能障碍等情况。结论: 有AV搜索功能DDD/R起搏器可减少非必须的心室起搏,安全可靠。     

起搏器最小化心室起搏功能对心脏重构和心房颤动发生率的影响

目的观察双腔起搏器最小化心室起搏功能对患者心力衰竭和心房颤动(房颤)发生率的影响。方法选择青岛阜外医院心脏中心32例具备心室起搏管理(MVP)、房室间期自动搜索(Search AV+)或心室自身优先(VIP)功能的双腔起搏器患者为试验组,开启最小化心室起搏功能,30例不具备MVP、Search AV+或VIP功能的双腔起搏器患者设为对照组,延长房室间期至固定值。于术后1周,12个月,24个月进行起搏器程控、超声心电图、临床心功能评价和实验室检查,观察患者心脏结构、功能以及房颤发生率的变化。结果试验组32例(男性15例),年龄72.6±7.2岁;对照组30例(男性14例),年龄76.4±8.5岁。与对照组比较,试验组患者心室起搏比例明显降低[(26.2±20.1)%vs.(59.2±21.4%),P0.01],NT-pro BNP[(234±87)pg/ml vs.(876±134)pg/ml,P0.050]和内皮素[(1.5±0.08)ng/L vs.(5.6±0.10)ng/L,P0.05]水平更低;左房内径[(39.8±6.4)mm vs.(43.5±7.8)mm,P0.050]和左室舒张末内径[(54.7±5.7)mm vs.(60.7±6.4)mm,P0.05]较小;射血分数[(0.52±0.04)%vs.(0.48±0.05)%,P0.05]较大;房颤负荷[(9.2±8.5)min/d vs.(45.8±23.1)min/d,P0.010]较轻。结论双腔起搏器开启最小化心室起搏功能,通过减少心室起搏比例,能够减少房颤发作以及保护心功能。     

心室起搏管理功能降低病窦综合征患者高比例的右室起搏

目的评估具有心室起搏管理(MVP)功能的双腔起搏器对高比例右室起搏的病窦综合征(SSS)患者的疗效。方法 35例SSS患者,房室传导正常或合并间歇性房室传导阻滞(AVB),至少植入了两年双腔起搏器(DDD/R),并计划更换,入组前1个月以上的心室起搏比例超过40%。均植入具有MVP功能的双腔起搏器,随机程控MVP启动(MVP on组,n=17)或者关闭(MVP off组,n=18)。术前、术后6个月行血浆脑钠肽(BNP)测定;心脏超声测定左室收缩末期内径(LVESD),左室舒张末期内径(LVEDD),左室射血分数(LVEF);并于术后6个月程控起搏器了解右室起搏比例、心房高频事件。结果术前两组血浆BNP及LVESD、LVEDD、LVEF比较无显著差异(P>0.05);术后两组有关心脏超声指标无明显变化(P>0.05)。MVP on组术后较术前血浆BNP有明显下降(P﹤0.05),与MVP off组比较,MVP on组术后右室起搏百分比、心房高频事件发生率均有显著下降(2.6%±0.6%vs 48.4%±10.5%,15.7%±2.3%vs 62.0%±7.8%;P﹤0.01)。结论具有MVP功能的DDD/R起搏器能降低高比例右室起搏的SSS的右室起搏比例及心房高频事件的发生率。     

AAISafeR起搏模式的长期随访观察

目的对置入具有AAISafeR功能的Symphony 2450起搏器的患者进行长期随访观察。方法入选40例患者,分别于置入起搏器后3个月、6个月,以后每年1次进行随访,观察左房内径(LAD)、左室舒张末期内径(LVEDD)及左室射血分数。通过起搏器程控计算心房起搏及感知百分比,心室起搏及感知百分比。同时记录房性心律失常的发生率。结果随访18±4.6(12～24)个月,心室起搏百分比23.5%±3.5%。与术前相比,术后LAD、LVEDD均有缩小(P<0.05)。相关分析显示,LAD、LVEDD与心室起搏百分比呈正相关。术后快速房性心律失常发作例数明显减少。结论AAISafeR起搏模式能够有效减少心室起搏百分比,减少房性心律失常的发生。     

双腔起搏器最小化心室起搏功能的临床应用

目的探讨双腔起搏器的最小化心室起搏(MPV)功能减少心室起搏的有效性及对血流动力学及房颤发生率的影响。方法观察98例植入DDD/R起搏器患者(打开MPV功能组49例,关闭MPV功能组49例)术后3、6、12个月的随访结果。结果打开MPV功能起搏器组右室起搏百分比明显减少(P<0.05);打开MPV功能起搏器组房颤负荷百分比在术后6个月和12个月减少(P<0.05);两组在植入起搏器术前术后心脏指数、左室舒张末径、左房内径、左室射血分数比较均无统计学意义(P>0.05)。结论打开MPV功能起搏器组在减少不必要的右室起搏及减少房颤发生率方面均优于关闭MPV功能组。     

AAISafeR起搏模式自身对照研究

目的分析患者置入具有AAISafeR功能的Symphony2450起搏器后,短期内心脏结构和功能改变的特点及其与心室起搏百分比之间的关系。方法共入选22例患者,采用随机、单盲、自身前后交叉对照原则,观察同一患者在不同起搏模式下(AAISafeR和DDD)左房内径(LAD)、左室舒张末径(LVEDV)、左室收缩末径(LVESV)及左室射血分数(LVEF)的变化。结果不同起搏模式分别观察3个月后,LAD缩小(38.5±5.7mmvs39.7±4.5mm,P<0.05),但LVEDV、LVESV及LVEF变化不大。与DDD模式相比,AAISafeR模式下心室起搏、感知百分比有显著性差异(分别为67.49%±13.09%,43.89%±12.28%vs45.23%±11.15%,64.88%±15.08%,P均<0.05)。结论AAISafeR模式可有效减少心室起搏的百分比,较高比例的心室起搏百分比短期内(3个月)可影响心腔结构的重塑,但尚未引起心室功能的改变。     

急性心肌梗死患者入院时血浆心房利钠肽浓度与心脏死亡危险

冠心病监护病室开创20年以来,急性心肌梗死(AMI)后心律失常人数减少,以致左室功能障珥成为主要死亡原因。左室功能障碍患者被证明血浆心房利钠肽(ANP)浓度明显增加,并与左室功能良好相关。 55例AMI,症状开始12h内收入冠心病监护病室,心功能Ⅰ级24例、Ⅱ～Ⅳ级31例。按入院时血浆ANP浓度分为两组:组1(22例)血浆ANP≤200pg/ml,组2(33例)血浆ANP>200pg/ml。51例正常健康人作为对照组,其血浆ANP浓度25～200(平均83±38.4)pg/ml(正常范围)。     

一种新的双腔起搏模式——AAISafeR与DDD模式的对比临床研究

目的评价存在自身房室传导置入双腔起搏器的患者,分别以DDD模式和AAISafeR模式工作3个月后心室起搏百分比以及临床指标。方法因病窦综合征置入Ela Symphony D 2450 DR2550系列双腔起搏器的患者30例,随机分为两组DDD组和AAISafeR组,3个月后交叉程控为AAISafeR和DDD,再随访3个月。结果没有观察到与AAISafeR有关的不良反应;AAISafeR模式能显著降低心室起搏的百分比51.3%(2%～91%)与0.9%(0～3%),(P=0.001);2.94%(0～18%)与41.18%(0～65%),(P=0.000);DDD模式工作3个月,左房直径、左室舒张末径、左室收缩末径均比术前增加,左室射血分数降低,差异有显著性,AAI SafeR模式工作3个月,除左房内径明显增大外,其余指标无明显改变;30例患者,在6个月的随访中,21例因不同程度的房室传导阻滞,AAI模式暂时转换为DDD模式。结论AAISafeR起搏模式能够有效降低心室起搏的百分比;AAISafeR起搏模式能够在出现房室传导阻滞的情况下,迅速安全的转换为DDD模式。     

阿托伐他汀对植入双腔心脏起搏器的病态窦房结综合征患者左心室重构的影响

目的:探讨阿托伐他汀对植入双腔心脏起搏器(DDD)的病态窦房结综合征(SSS)患者左心室重构的影响。方法:选择在本院心血管内科住院并行DDD植入术的SSS患者108例为研究对象,随机分为常规治疗组(54例,起搏器植入后给予常规抗心律失常药物治疗)和阿托伐他汀组(54例,在常规治疗基础上给予阿托伐他汀治疗)。6个月后,比较两组手术前后左心室重塑指标、心功能指标、心房高频事件(AHREs)发作次数、AHREs持续时间等变化,同时记录治疗期间不良反应。结果:术后6个月,与常规治疗组比较,阿托伐他汀组左室射血分数(LVEF)[(63.91±5.12)%比(65.84±4.85)%]显著提高,LVEDd[(44.26±4.05)mm比(42.48±3.84)mm]和LVESd[(30.89±3.17)mm比(29.31±2.84)mm]显著减小(P<0.05或<0.01);血浆BNP[(127.84±30.84)pg/ml比(98.18±25.95)pg/ml]和NT-proBNP[(313.57±61.56)pg/ml比(269.46±54.48)pg/ml]水平显著降低(P均=0.001);AHREs发作次数[(285.38±45.54)次/年比(263.36±51.28)次/年]和AHREs时间[(17.32±7.54)h/年比(12.74±7.32)h/年]均显著减少(P<0.05或<0.01)。两组治疗期间均未出现肌溶解、转氨酶显著升高(3倍以上)等不良反应。结论:阿托伐他汀可逆转双腔心脏起搏器植入术后病态窦房结综合征患者左心室重构,提高心功能,减少术后心房颤动的发生,且安全性高。     

Multicenter, prospective, randomized safety and efficacy study of a new atrial-based managed ventricular pacing mode (MVP) in dual chamber ICDs

BACKGROUND: Ventricular desynchronization caused by right ventricular pacing may impair ventricular function and increase risk of heart failure (CHF), atrial fibrillation (AF), and death. Conventional DDD/R mode often results in high cumulative percentage ventricular pacing (Cum%VP). We hypothesized that a new managed ventricular pacing mode (MVP) would safely provide AAI/R pacing with ventricular monitoring and DDD/R during AV block (AVB) and reduce Cum%VP compared to DDD/R. METHODS: MVP RAMware was downloaded in 181 patients with Marquis DR ICDs. Patients were initially randomized to either MVP or DDD/R for 1 month, then crossed over to the opposite mode for 1 month. ICD diagnostics were analyzed for cumulative percentage atrial pacing (Cum%AP), Cum%VP, and duration of DDD/R pacing for spontaneous AVB. RESULTS: Baseline characteristics included age 66 +/- 12 years, EF 36 +/- 14%, and NYHA Class II-III 36%. Baseline PR interval was 190 +/- 53 msec and programmed AV intervals (DDD/R) were 216 +/- 50 (paced)/189 +/- 53 (sensed) msec. Mean Cum%VP was significantly lower in MVP versus DDD/R (4.1 +/- 16.3 vs 73.8 +/- 32.5, P < 0.0001). The median absolute and relative reductions in Cum%VP during MVP were 85.0 and 99.9, respectively. Mean Cum%AP was not different between MVP versus DDD/R (48.7 +/- 38.5 vs 47.3 +/- 38.4, P = 0.83). During MVP overall time spent in AAI/R was 89.6% (intrinsic conduction), DDD/R 6.7% (intermittent AVB), and DDI/R 3.7% (AF). No adverse events were attributed to MVP. CONCLUSIONS: MVP safely achieves functional atrial pacing by limiting ventricular pacing to periods of intermittent AVB and AF in ICD patients, significantly reducing Cum%VP compared to DDD/R. MVP is a universal pacing mode that adapts to AVB and AF, providing both atrial pacing and ventricular pacing support when needed.     

Secretion of atrial natriuretic peptide during artificial pacing: assessments including the influence of ventriculoatrial conduction]

Secretion of atrial natriuretic peptide (ANP) depends on the atrial wall distension which may be caused by ventricular pacing. This study was designed to assess the differences in plasma ANP level between DDD and VVI pacing. We measured ANP from venous blood samples using radio-immunoassay in patients with the sick sinus syndrome (n = 8) and atrioventricular block (n = 2) following DDD implantation. Measurement was made under control conditions during DDD and 15-180 min after the pacing mode was changed to VVI and 60 min after returning to DDD. Serum epinephrine (E), norepinephrine (NE), renin (R) and aldosterone (A) levels were also measured prior to and every 30 min after pacing mode changes. The plasma ANP concentration changed from 71.3 pg/ml (normal value) with DDD to 126.8 (15 min), 180.6 (30 min), 221.8 (60 min), 219.2 (90 min), 270.1 (120 min), 145.4 (150 min) and 115.1 pg/ml (180 min) with VVI. It increased markedly, then gradually decreased. It returned to the control value (66.6 pg/ml) in 60 min with DDD, and it reached the peak level with VVI within 60-120 min, and the peak was significantly higher than that for DDD. The increase related to the retrograde ventriculoatrial conduction during VVI pacing. There was no significant change in the NE, E, R and A concentrations. Systolic blood pressure decreased 15 mmHg in VVI and returned to normal by DDD. These results indicated that plasma ANP levels is elevated by VVI pacing, though it was not explained by ventricular pacing alone.     

Randomized pilot study of a new atrial-based minimal ventricular pacing mode in dual-chamber implantable cardioverter-defibrillators

OBJECTIVE: We hypothesized that a new minimal ventricular pacing mode (MVP) that provides AAI/R pacing with ventricular monitoring and back-up DDD/R pacing as needed during AV block (AVB) would significantly reduce cumulative percent ventricular pacing compared to DDD/R. BACKGROUND: Conventional DDD/R mode often results in high cumulative percent ventricular pacing that may adversely affect ventricular function and increase risk of heart failure and atrial fibrillation. METHODS: MVP was made operational in 30 patients with DDD/R implantable cardioverter-defibrillators (ICDs) and no history of AVB. Patients were randomized to one week each in DDD/R and MVP. Holter monitor recordings (ECG, intracardiac electrograms, and event markers) and device diagnostics were analyzed for cumulative % atrial paced (Cum%AP), cumulative percent ventricular pacing, and frequency and duration of DDD/R pacing back-up. Diaries were used to report symptoms. RESULTS: Age of the study population was 61 years +/- 12 years and 83% were male. Baseline PR interval was 204 ms +/- 32 ms and programmed AV intervals (DDD/R) were 200 ms +/- 50 ms (paced)/167 ms +/- 54 ms (sensed). Cum%AP was similar between MVP and DDD/R (47.9 +/- 37 vs 46.3 +/- 36). Cumulative percent ventricular pacing was significantly lower in MVP vs DDD/R (3.79 +/- 16.3 vs 80.6 +/- 33.8, P < .0001). Back-up DDD/R pacing during MVP operation due to transient AVB occurred in 10% of patients (9.3 +/- 7.4 [range 1-15] episodes/patient-day, duration 39.7 minutes +/- 156 minutes). Fifteen percent of AV intervals during MVP operation exceeded 300 ms. No significant symptoms were reported during MVP operation. CONCLUSIONS: MVP dramatically reduced cumulative percent ventricular pacing compared to DDD/R while maintaining AV synchrony and providing sensor-modulated atrial pacing support. Intermittent oscillations between MVP and DDD/R during transient AV block appeared safe and well tolerated.     

不同起搏模式对病态窦房结综合征患者心功能长期影响的探讨

目的前瞻性观察不同起搏模式对心功能长期的影响并探讨可能机制。方法 185例病态窦房结综合征（SSS）患者均采用常规方法经锁骨下静脉途径成功置入永久双腔心脏起搏器,术后即刻程控起搏器,根据SAS软件的PROC程序产生一组随机序列分为AAI（92例）及DDD（93例）起搏组。采用心脏超声观察术前,术后1、2、5年左室舒张末容积（LVEDV）、左室收缩末容积（LVESV）及左室射血分数（LVEF）的变化,比较两种起搏模式对左心功能的影响;术后1、2及5年进行随访结合起搏器程控记录房颤发生并记录DDD起搏组右室起搏百分比（VP%）,探讨VP%与心功能变化及房颤发生的关系。结果 AAI起搏组术前,术后1、2、5年随访LVEDV,LVESV及LVEF比较差异无统计学意义（P〉0.05）,DDD起搏组术前、术后1、2、5年LVEDV差异无统计学意义（P〉0.05）,术后5年LVESV（60.33±13.28）ml较术后1、2年增加,差异有统计学意义（F=2.7388,P〈0.05）,术后5年LVEF（41.75±8.74）%较术前、术后1、2年明显降低,差异有统计学意义（F=33.4393,P〈0.05）;AAI组与DDD组房颤的发生差异有统计学意义（P〈0.05）。术后5年DDD组中〈50%VP%,组中出现房颤患者为3例,≥50%VP%组中出现房颤患者为15例,两组之间房颤的发生率差异有统计学意义（P〈0.05）。结论在DDD起搏模式下,高的VP%可对患者的左心功能造成损害并增加房颤的发生。对于不合并房室传导阻滞的SSS患者,AAI起搏较DDD起搏能使患者更受益。