心室具有自动阈值夺获功能起搏器的远期随访

目的：观察双腔心室自动闽值夺获起搏器的长期各参数变化，节能功能及起搏安全性。方法：对65例患者植入具有AC功能双腔起搏器，观察术中、术后6个月心室起搏阈值，输出电压，ER振幅，阻抗和极化电位及自动工作方式转换功能。结果：术后心室起搏阈值早期升高1．10V±0．18V以后逐渐稳定，长期心室起搏电压仅在0．45V±0．13V。63例在术后测定各参数即刻启动AC功能并于术后1周及6个月随访心室各参数变化。1例术中R波振幅15．2mV，ER值为10．4mV，极化电位0．4mV，术后发生心房颤动给普罗帕酮600mg转律，测试时发现AC功能自动关闭，当时ER值9．4mV，极化电位0．8mV，再测ER值10．2mV，极化电位0．4mV，AC功能可以打开并工作正常。比较术中、术后1周起搏阈值升高，P〈0．05，术后一周与6个月相比起搏阈值下降，P〈0．05。其余无统计学意义。结论：具有自动阈值夺获功能的双腔起搏器，高效能保护起搏电压，耗能低而且安全性好，能满足患者的生理需要。

Function of Ventricular Automatic Capture by Threshold for Pacemaker:a long-term follow up

Objective：To observe changes on some parameter of the dual chamber pacemakers with ventricular auto - capture （AC） function, energy and safety. Methods： The dual chamber pacemakers with ventricular autocapture function were implanted in 65 patients with heart disease from our hospital between Jan. 2001 and Oct. 2006. Stimulation threshold level, out -put amplitude, evoked response （ER）, impedance and polarization potential were measured 1 week and six months after implantation. Results： Follow - up results of one week and the sixth month after implantation was as following： the mean ventricular pacing threshold rose 1.10V ＋0.18V in the early postimplantation, then it dropped and remained stable. And the long- term pacing -out- put amplitudes of those with AC function turned - on were 0.45V ＋ 13V. There was 1 case whose ER, polarization potential and R-wave were 10.4mV, 0.4mV, 15.2mV during operation and had a atrial fibrillation after operation but AC function recovered after giving propafenone 600mg orally, the ER and polarization potential were still in the normal range （ ER was 9.4mV, polarization potential was 0. 8mV） ;other than sinus rhythm returned on, AC function was activated （ER 10.2mV, polarization potential 0.4mV）. The ventricular pacing threshold has a difference among during, 1 week and six months after operation （ P 〈 0.05 ）, as well as between. Conclusions： The dual chamber pacemaker with ventricular auto - capture function is better energy saving, and can satisfy with patient＇ s physiological need. It can reduce extra energy consumption too.