双腔起搏器优化程控对长QT综合征的疗效影响

目的探讨双腔起搏器联合B受体阻滞剂治疗先天性长QT综合征（LQTS）的最优程控方式。方法12例正规药物治疗无效或无法耐受的LQTS患者植入DDD起搏器，分别测量不同频率起搏时QT／QTc间期的变化，然后以80次／min的频率起搏，选择性地程控开放或关闭起搏器的部分相关功能，并根据PR间期和血压情况调整B受体阻滞剂用量，随访患者植入术后心脏事件的发生情况和心功能变化情况。结果起搏频率越快，QT／QTC间期越短。80次／min频率起搏时QT／QTc间期可基本恢复正常，植入术后心脏事件发生次数明显减少（P〈0．01），且对心功能无影响。结论双腔起搏器联合B受体阻滞剂治疗LQTS时，最优程控方式是：以80次／min的频率起搏并程控关闭滞后、睡眠、自动终止起搏器介导的心动过速和自动阈值夺获功能，开放设置室性早搏后反应、频率适应性和房室结优先功能。

Therapeutic effect of a dual-chamber pacemaker with the optimized program-control mode on long QT syndrome

Objective To explore the optimized program-control mode of a dual-chamber pacemaker combined with β-blocker to treat congenital long QT syndrome (LQTS). Methods Twelve LQTS patients in our hospital that still have symptoms despite use of regular drug therapies or that can not endure the therapies were implanted with DDD cardiac pacemaker. The QT/QTc intervals of those patients were measured at different pacing rates respectively. Their cardiac pacemakers were all programmed to selectively turn on and turn off some related functions at the pacing rate of 80 beats/min. The dosage of β-blocker was adjusted according to the patients' PR intervals and blood pressures. The MACE and the cardiac function of the patients were recorded after operation. Results The measured QT / QTc interval decreased with the pacing rate increasing. The pacing rate of 80 beats/min can make QT/QTc interval basically normal. The MACE of the patients were statistically declined (P =0. 003)and no negative effect on cardiac function was found during the follow-up. Conclusions The optimized program-control mode of a dual-chamber pacemaker combined with β-blocker to treat congenital LQTS are:to pace at the rate of 80 beats/min and program to turn off lag,sleep,automatic preventing PMT and automatic threshold-capture feature and turn on the PVC,rate adaptation and atrioventricular node priority function.