双腔起搏器房室间期自动搜索功能对右心室起搏比例影响的临床研究

目的比较植入双腔起搏器患者房室（AV）间期自动搜索功能（Search AV）打开与固定长AV间期起搏，对右心室起搏比例的影响。方法入选60例病态窦房结综合征或间歇性Ⅱ度或Ⅲ度AV传导阻滞患者，均安装双腔起搏器。程控首先关闭Search AV功能，固定长AV间期（起搏房室间期220ms，感知房室间期200ms）起搏3个月，后程控打开Search AV 3个月，自身对照，比较其心房起搏比例、心室起搏比例及高频心房事件次数。再根据患者是否1：1房室传导分为2个亚组，自身对照分别比较其心房起搏比例、心室起搏比例及高频心房时间次数。结果58倒患者完成随访，固定长AV间期起搏时比Search AV（＋）自动搜索功能打开时的心室起搏比例、高频心房事件次数都高，分别为（70．5±12．4）％vs（22．4±8．3）％，（86±16）次VS（31±11）次（P=0．007，P=0．006）；而心房起搏比例二者差异无统计学意义。在1：1房室传导组（33例）及非1：1房室传导组（25例）两亚组比较中，均得出相同结果。结论Search AV功能可以减少不必要的右心室起搏，减少高频心房事件。

Clinical observation on influence of right ventricular pacing percentage using a Search AV algorithm in dual chamber pacemaker

Objective To study the influence of two strategies （Search AV algorithm and fixed long AV delay pacing） on the percentage of right ventricular pacing in dual chamber pacemaker. Methods A total of 60 patients were enrolled in this study,all of which were with implanted dual-chamber pacemakers due to sick sinus syndrome or, Ⅱ or Ⅲ degree paroxysmal atrioventricular block. All the patients were paced with fixed long AV delay pacing modality for three months,then Search AV was switched on for additional three months. The percent of atrial pacing, ventricular pacing and atrial high frequence events were recorded during the six months＇ follow-up. Patient cohorts were defined into two groups according to the assessment of conduction via a 1 ： 1 AV conduction test. The cohorts percent of atrial pacing, ventricular pacing and atrial high frequence events were compared respectively. Results Fifty-eight patients completed the follow-up study. The percent of ventricular pacing and atrial high frequence events were higher during fixed long AV delay pacing compared to Search AV（＋） on （70.5±12.4）% vs （22.4±8.3）%, P =0. 007; （86±16） times vs （31±11） times, Ps= 0. 006）. There was no difference in atrial pacing percent between fixed long AV delay pacing and Sereh AV（＋）off pacing（ P = 0. 918）. The similar results were obtained in both groups with intact 1 ： 1 AV conduction （n = 33）and without intact 1 ： 1 AV conduction （n = 25）. Conclusion In dual chamber pacing patients, compared with fixed long AV delay pacing, the Search AV algorithm reduces unnecessary right ventrieularpacing,and reduces atrial high freqhence events.