起搏器植入后常见的认识误区

正近年来,心律失常在城市中日益高发。统计显示,80%的心脏相关死亡事件是由严重的心律失常引起的。缓慢型心律失常,如窦性心动过缓、窦性停搏、房室传导阻滞等疾病,都可通过植入心脏起搏器,使患者的心脏功能恢复正常。尽管安装心脏起搏器的患者不断增多,但不少病人对这一治疗方式缺乏科学认识,存在着一些认知误区。误区1:永久起搏器可永久使用     

十二导联动态心电图对不明原因晕厥诊断价值的研究

目的 探讨十二导联动态心电图对不明原因晕厥的检测价值,为临床诊疗提供依据。方法 对127例病因不明的晕厥患者行十二导联动态心电图监测,并嘱咐患者在监测过程中尽可能诱发晕厥,记录晕厥发生时间及心电图变化。结果 127例患者中监测期间发生晕厥者34例,其中发生心律失常的有28例,占82.3%;对晕厥患者心律失常类型的构成比分析发现,窦性心动过缓伴窦性停搏的比例最高（39.3%）,其余依次为房室传导阻滯、室上性心律失常、室性心律;晕厥的发生与心室停搏时间相关,心室停搏时间≥3.0s晕厥发生率增加。结论 十二导联动态心电图对心源性晕厥的诊断有重要意义,能为其确诊提供依据。     

食管窦房结功能测定与动态心电图在晕厥诊断中的价值

目的探讨食管电生理窭房结功能测定与动态心电图（Holter）在不明原因晕厥中的诊断价值。方法对82例不明原因晕厥患者进行食管电生理窦房结功能测定并行动态心电图检查。结果82倒晕厥患者行食管电生理测定窦房结恢复时间（SNRT）≥2s者38例（46．3％），SNRT≥5s者1l例（13．4％）。82例患者Holter检查49例（59．8％）记录到各种类型心律失常，Holter检查中21例（25．6％）发生晕厥，18例记录到与晕厥有关的心律失常。在SNRT≥2s的38例患者中17例记录到窦性心动过缓伴窭性停搏，11例SNRT≥5s的患者9例记录到窦性心动过缓伴窦性停搏。同时发现心电图RR间期与晕厥相关，发生晕厥的21例患者中RR间期≥3s的28次，而RR间期〈3s的198次中无1例发生晕厥，二者有显著差异，P〈0．01。结论在不明原因晕厥诊断中食管电生理窦房结功能测定是有用方法，但患者痛苦，有一定危险性，Holter不失为有价值的筛选工具。     

永久起搏器术后再发晕厥20例病因分析

目的 探讨永久起搏器术后再发晕厥的因为.方法 回顾性分析1050例永久起搏器术后随访期间再发晕厥的20例患者的临床资料.通过电话随访、常规检查、起搏器程控、动态心电图、持续心电监护、肺血管计算机断层扫描、冠状动脉造影、倾斜试验等检查.结果 平均随访(47±31)个月,共有20例患者发生晕厥.明确病因者17例,其中室性心动过速、心室颤动相关的晕厥患者9例.血管迷走性晕厥3例,直立性低血压2例,起搏器相关2例,肺栓塞1例.病因不明者3例.结论 永久起搏器术后再发晕厥因为复杂,排除起搏器功能障碍后应考虑室性心动过速、心室颤动、血管迷走性晕厥、直立性低血压、肺栓塞等病因.     

动态心电图与常规心电图诊断冠心病的效果和准确率对比观察

目的观察动态心电图与常规心电图诊断冠心病的效果和准确率。方法选取2017年10月-2019年3月于我院治疗的118例冠心病患者为研究对象,将其中仅接受常规心电图检查的59例患者归为对照组,除常规心电图外同时接受动态心电图检查的59例患者归为观察组,通过观察两组患者的阳性诊断率和心电指标,分析两种方法的诊断效果。结果观察组患者的阳性检出率为71.79%,与对照组患者的阳性检出率比较,差异有统计学意义(P0.05);观察组患者的窦房阻滞检出率为22.03%、房室阻滞检出率为16.95%、短阵性房颤检出率为18.64%、窦性心动过速检出率为25.42%、窦性心动过缓检出率为23.73%、期前收缩检出率为79.66%、房性心动过速检出率为35.59%、缺血性ST-T改变检出率为40.68%,与对照组患者的窦房阻滞、房室阻滞、短阵性房颤、窦性心动过速、窦性心动过缓、期前收缩、房性心动过速、缺血性ST-T改变的检出率比较,差异均有统计学意义(P0.05)。结论冠心病患者接受动态心电图检查,可以提高疾病的诊断准确率,值得推广应用。     

社区医疗中动态心电图诊断病窦综合征的价值分析

病态窦房结综合征（病窦综合征）是指窦房结病变导致其功能障碍，产生多种心律失常及各种临床表现的综合征。多发生于老年人。动态心电图是检测病窦综合征最常用、简单、实用的一种检测手段。我院常规心电图检查的门诊及住院138例窦性心动过缓患者均行动态心电图检查。报告如下。     

永久心脏起搏器植入患者的自我管理水平及影响因素分析

目的 探讨永久心脏起搏器植入患者的自我管理水平,并分析影响因素。方法 选取2019年4月至2022年3月医院收治的72例永久心脏起搏器植入患者,参照冠心病自我管理行为量表(CSMS)评估患者的自我管理水平,设计一般资料调查问卷,收集患者的一般资料,采用线性回归分析永久心脏起搏器植入患者自我管理水平的相关影响因素。结果 72例永久心脏起搏器植入患者的平均CSMS评分为(88.94±5.76)分,处于中等偏下水平;不同文化水平、社会支持、居住状况、心理状况的永久心脏起搏器植入患者的CSMS评分比较,差异有统计学意义(P<0.05);其他不同资料特征患者的CSMS评分比较,差异无统计学意义(P>0.05);线性回归分析结果显示,文化水平为小学及以下、社会支持水平低、独居、心理状况不良均为永久心脏起搏器植入患者自我管理水平的影响因素(P<0.05)。结论 永久心脏起搏器患者自我管理水平处于中等偏下水平,可能受文化水平低下、社会支持水平低、独居、不良心理状况等因素影响。     

动态心电图对病态窦房结综合征的诊断价值分析

目的探讨动态心电图对于病态窦房结综合征（SSS）的诊断价值。方法对我院门诊及住院患者窦性心动过缓（心率〈50次／min）者进行阿托品试验。选择75例阿托品试验阳性者做动态心电图检查、分析。同期健康体检者56例做对照。结果75例阿托品试验阳性者动态心电图检测符合24h总心搏〈80000次且24h最慢心率〈40次／min、最快心率〈90次／min者52例。而对照组无1例24h总心搏〈80000次。部分并有窦性停搏（静止）、窦房阻滞、房室传导阻滞、慢快综合征、心室停搏、交界性逸搏及逸搏心律、期前收缩等心律失常。结论动态心电图可全面了解患者的心律和心率的变化,能明显提高心律失常的检出率,是早期诊断病态窦房结综合征的最可靠的方法。     

比较临床心脏病诊断过程中采用动态心电图与常规心电图的应用价值

目的:分析比较临床心脏病诊断过程中采用动态心电图与常规心电图的应用价值.方法:在我院自2014年1月至2017年1月收治的心脏病确诊患者中选取64例作为临床研究对象,均同时采用动态心电图与常规心电图进行检查,观察比较两种检查方法的诊断结果.结果:本组患者经动态心电图检查示,室上性期前收缩检出率、室性期前收缩检出率、阵发性心房纤颤检出率、阵发性室上性心动过速检出率、窦性心动过缓检出率、窦性心动过速检出率、室性心动过速检出率、阵发性房速检出率以及窦性静止与窦房传导阻滞检出率均高于常规心电图检查结果,差异显著,有统计学意义(P<0.05);心房纤颤检出率和房室传导阻滞检出率与心电图检查结果相比无显著差异(P>0.05).结论:在临床心脏病诊断过程中,采用动态心电图检查的诊断准确率高于常规心电图检查,为临床首选诊断方法,具有较高应用及推广价值.     

心脏起搏器术后的再晕厥

永久人工心脏起搏器即用低能量电脉冲刺激心脏使之发生激动 ,以治疗严重心动过缓 ,尤其伴有晕厥的心动过缓取得了良好的效果。同时我们也注意到安置心脏起搏器术后患者出现晕厥或原有晕厥复发。心脏起搏器术后的再晕厥的原因 ,可能与起搏器系统故障或起搏方式有关 ,也可能是其他原因引起的。1　与心脏起搏系统有关的晕厥人工心脏起搏器系统由具脉冲发生器 (起搏器)和与之匹配的电极导管组成。脉冲发生器均能通过与心肌相接触的电极导管发放脉冲电流和感知心内信号。所以如起搏器功能失常 ,电极导管与心肌接触面异常 ,电极导管与起搏器连接异…     

Outcomes of permanent pacemaker implantation for carotid sinus hypersensitivity in a district general hospital with a Falls Fits Faints and Funny Turns Clinic

Permanent pacemaker implantation is considered for carotid sinus hypersensitivity with asystolic pause of > 3 seconds during carotid sinus massage, with or without associated systolic blood pressure drop of > 50 mmHg. AIMS: To assess the outcome of treatment with dual chamber permanent pacemaker implantation for carotid sinus hypersensitivity in a district general hospital and to compare our practice with available national data. METHODS: Patients presenting with syncope, dizziness or unexplained falls were initially assessed as outpatient and investigations, commonly cardiovascular were performed including tilt table test with carotid sinus massage to look for carotid sinus hypersensitivity, vasovagal syncope and postural hypotension. A retrospective analysis was performed on patients who had pacemaker implantations for carotid sinus hypersensitivity. RESULTS: Fifty pacemaker implantations were performed, 14 (28%) were for carotid sinus hypersensitivity. Mean follow-up period was 10 months. Age range was 56-88 (mean = 71.9) years. In the eighteen months prior to pacemaker implantation, 71.4% of patients had syncope, 64% dizziness and 50% had unexplained falls. Following pacemaker implantations, only 2 (14.3%) had symptoms. Scottish national figures show 13.6% of all new pacemaker implants were for carotid sinus hypersensitivity, and in district general hospitals this was 16%. CONCLUSIONS: Health benefits for patients presenting with syncope dizziness and falls can be achieved by cardiovascular investigations including tilt table testing. We have shown carotid sinus hypersensitivity is successfully treated with pacemaker implantation in a district general hospital setting and this type of clinic has an impact on the rate and type of new pacemaker implantation.     

老年病态窦房结综合征临床特征

目的　探讨老年病态窦房结综合征 (SSS)临床特征。方法　对 5 0例老年SSS发病年龄、病因、病程、症状和动态心电图 (DCG)进行回顾分析。结果　 70岁以后男性SSS发病率明显上升 ,病因依次是冠心病 ,特发性SSS ,高血压性心脏病 ,老年退行性心脏瓣膜病以及心肌病。老年SSS平均病程长约 10年 ,且与DCG分型有关 ,III型的最长 ,IV型的最短 ,I型与II型相近。早期DCG多为阵发性房颤 ,阵发性室上性心动过速 ,频发房早 ,窦房阻滞 ,房室传导阻滞和束支传导阻滞 ,以后逐渐演变成四种类型的SSS。症状晚于心律失常出现 ,早期为心悸、头昏和乏力 ,晚期为黑朦 ,晕厥及心绞痛和心衰加重。起搏器安置时机取决于临床症状而不是DCG分型。结论　SSS多发于 70岁以上男性 ,多种病因 ,起病隐匿 ,病程漫长。早期心电图和症状不典型 ,晚期DCG可分成四种类型 ,晚期症状黑朦和晕厥等 ,症状严重程度决定起搏器安置时机。连续DCG检测是评估老年窦房结功能常用的有效的方法。     

Prinzmetal angina pectoris associated with 3rd degree atrioventricular block

The authors report on the case of a 61 year-old female patient who was repeatedly taken to hospital because of chest pain and temporary loss of consciousness. During her hospitalization there was no ST elevation on the ECG, sinus bradycardia, other times atrial fibrillation was detected. The diagnosis was made by Holter monitoring three years after the onset of complaints. At this time chest pain set in after midnight, which was followed by loss of consciousness. Significant ST elevation and IIIrd degree AV block were detected. The coronarography showed non-significant coronary stenosis. According to the vasospastic patomechanism nitrate, calcium antagonist and acetylsalicylic acid therapy was administered and because of the complete AV block leading to syncope a VVI, M pacemaker was implanted. During the two years passed since the implantation of the pacemaker the patient had chest pain only once and it was not accompanied by syncope.     

临时人工起搏器在小儿暴发型心肌炎中的应用体会

目的：探讨临时人工起搏器在小儿暴发型心肌炎中的应用经验。方法：所有患儿采用静脉途径,包括锁骨下静脉,颈内、外静脉,股静脉及肱静脉。先放置血管鞘管,再沿该鞘管送人临时心脏起搏导管,借助心电图、超声或x线下导管头端定位于右心室心尖部。选择抑制型同步起搏器,R波抑制型起搏器（vvi）。设置起搏频率95—135次train,起搏阈值电流5mA,起搏感知电压10mV。结果：24例患者均在入院后24h内行临时心脏起搏器置人术,14例在X线透视下完成,10例于床旁放置。16例患儿康复,8例死亡。起搏导管放置时间短者1．5h,最长8d。住院时间最短8h,最长40d。结论：小儿暴发型心肌炎应早期采取积极的综合治疗。如病程中出现心室率过慢（〈50次／min）、或室率逐渐下降,或其他严重致死性心律失常等,应及早安装临时心脏起搏器。     

New indications for cardiac pacing

Over the past decades, the pacemakers have become the standard treatment for patients with symptomatic sinus node disease or high grade atrioventricular block. With the development of pacemaker technology, attempts have been made to apply pacing to the treatment of problems other than symptomatic bradycardia. These problems include pacing to prevent atrial arrhythmia, improve hemodynamic function and to prevent neurocardiogenic syncope. The aim of modern pacing is not only reducing mortality but also improving quality of life and reducing morbidity. Ongoing studies will help to identify better the patient population that benefits most of this treatment.     

人工心脏起博器置入术并发症的预防及护理

目的 探讨人工心脏起博器置人术并发症的护理及有效预防措施.方法 对2010-2011年期间心内科收治的562例因病态窦房结综合征而进行人工心脏起博器置入术患者的临床资料进行回顾分析.结果 成功置入人工心脏起博器562例,其中VVI427例,DDD117例,ICD18例.24例出现了并发症,其发生率为4.27％,包括起博器综合症7例,囊袋出血6例,囊袋感染5例,心律失常2例,电极脱位2例,右室电极穿孔1例,气胸1例.结论 人工心脏起博器置入术后并发症的发生率虽然较低,但后果严重.术前采用有效的健康教育,术中医护密切配合,术后细心、恰当的护理有助于预防心脏起博器置人术并发症的发生.     

Prevention of atrial fibrillation by atrial-based pacemaker implantation

A large number of studies have demonstrated the long term disadvantage of single lead ventricular pacing in sick sinus syndrome. Ventricular pacing mode predicts chronic atrial fibrillation in patients with preimplant paroxysmal atrial fibrillation. The goal of the report was to study the effectiveness of single atrial and dual chamber (atrio-ventricular sequential) pacemaker treatment in the prevention of atrial fibrillation for patients with sick sinus syndrome complicated with paroxysmal atrial fibrillation. In our university hospital 16 atrial based 5 and dual chamber 11 pacemaker were implanted for treatment of patients with sick sinus syndrome (with or without AV conduction disturbances) complicated with paroxysmal atrial fibrillation. The mean age were 61 (24-78), nine males and seven females. Before or during pacemaker implantation sinus node and AV node function analysis, and echocardiography were performed. There were no surgical complications, lead and/or generator failure. All patients had routine follow-up performed at 4 weeks, 3 months, 6 months. Mean follow up was 31 +/- 8 months (range 3 to 93 months). The atrial based and dual chamber pacing were effective in 90% of our cases. In one patient the treatment had to be combined with propafenone. According to our result, the atrial based pacing may be used to reduce the incidence of atrial fibrillation with careful programming of the base atrial pacing rate, and it is associated with lower frequencies of thromboembolic complications and pacemaker syndrome.     

Malignant arrhythmia

About 5 percent of the arrhythmias are serious, life threatening, malignant arrhythmias (MA). The MA is regularly associated with organic heart diseases (coronary heart disease, cardiomyopathy, valvular heart diseases), but a MA can develop without cardiac disorders e.g. in long QT syndrome or WPW syndrome. The most frequent type of the MA is the ventricular tachycardia (VT), mostly the sustained VT, not rarely degenerating to ventricular fibrillation (VF). The primary VF represents a rarer form of MA. The usual type of MA is the tachycardiac form, but there exists a MA with dominating bradycardia (bradycardia syncope, tachycardia associated with long lasting bradycardia). In the diagnosis of MA new investigatory methods (signal averaged electrography with high amplification, Holter monitoring, programmed electrical stimulation) play an important role. In the therapy of the MA the first step is the treatment of the cardiac disease involved in the pathogenesis of the MA. At present only about the 40% of the MA can be effectively treated with antiarrhythmic drugs. The pacemaker therapy is very efficacious in the bradycardiac type of MA. Cardiodefibrillator pacemaker can be used for the treatment of grave VT or VF. Electrical transvenous catheter ablation, heart surgical intervention can also be applied in the treatment of special MA. The prognosis of VA was very serious a decade ago, now with application of newer therapeutical procedure the prognosis of MA is permanently improving.