不同起搏方式对病窦综合征患者房颤发生率的影响

目的　比较病窦综合征患者经心室按需起搏 (VVI)和心房起搏 [包括单心房起搏(AAI)、房室双腔起搏 (DDD)和双房起搏 ]治疗术后前 5年房颤的发生率。方法　对永久性人工心脏起搏器植入术后 5年以上、资料完整的 117例病窦综合征患者进行连续随访 ,平均随访时间(69.3± 6.7)个月 ,其中VVI起搏 83例 ,心房起搏 3 4例。随访内容包括临床表现、心电图和起搏器参数等 ,部分患者有Holter检查资料 ,分析 5年内两组病例房颤的发生率。结果　病窦综合征患者心脏起搏治疗前 5年内总的房颤发生率为 17.0 9% (2 0 /117) ,其中经VVI起搏的 83例患者房颤发生率为 2 2 .89% (19/83 ) ,经心房起搏的 3 4例患者房颤发生率为 2 .94% (1/3 4) ,后者房颤的发生率显著低于前者 (P <0 .0 1)。结论　在起搏治疗的病窦综合征患者中 ,术后前 5年心房起搏比心室起搏治疗有较低的房颤发生率     

长期心房与心室起搏对心房颤动发生率的影响

目的 为比较长期心房与心室起博心房颤动(Af)发生率的影响.方法 选择国内较大的三家医院1992年至1994年期间内安装人工心脏起搏器的病人,随访观察心房起搏(安装了AAI、AAIR、DDD及DDDR起博器)和心室起搏(植入了VVI或VVIR起搏器)Af的发生情况.结果 发现心室搏Af发生有逐年增加的趋势,Af4年发生率为33%,5年为41%,6年为52%.单纯心房起搏或房室顺序起搏Af发生率3%,而单纯心室起搏的病人中约40%出现Af,明显高于心房起搏组,P<0.01.结论 研究证明心房起搏可以减少Af的发生,为起搏方式的选择提供了一个客观根据,提示在临床实践中应该尽量选择AAI和DDD等生理性起搏方式.     

心房起搏比例对老年患者起搏术后心房颤动影响的回顾性分析

目的 通过观察无心房颤动（房颤）病史的老年病态窦房结综合征（病窦）患者在双腔起搏器植入后房颤负荷的变化,探讨心房起搏比例对老年患者起搏器植入后房颤的影响。方法 采用回顾性分析的研究方法。连续入选2006年1月至2012年1月在首都医科大学附属北京友谊医院心脏中心植入双腔起搏器的患者301例,进行常规随访（3.9±1.8）年,纳入最后统计的共283例患者。随访时读取起搏器内存储信息,记录心房早搏（房早）次数、最长房颤持续时间和房颤负荷;同时获取心房、心室起搏占总心搏的比例。评价心脏结构和功能。将心房起搏比例＞66%（66%为心房起搏比例中位数）设为高心房起搏比例组（141例）,心房起搏比例≤66%设为低心房起搏比例组（142例）。结果 与低心房起搏比例组相比,高心房起搏比例组患者房颤负荷（最长房颤持续时间和房颤负荷中位数）更低（P＜0.05）;且房早数量要少于低心房起搏比例组（P＜0.05）;但心室起搏比例在两组之间无明显差异（P＞0.05）。术前和术后两组患者的心脏结构和功能相比,差异无统计学意义（P＞0.05）。结论 对于起搏器植入后的房颤易患人群,高心房起搏比例可减少房颤事件。     

预防病态窦房结综合征心房颤动的心脏起搏模式探讨

目的 :观察何种心脏起搏模式能有效预防病态窦房结 (病窦 )综合征心房颤动 (房颤 )的发作。方法 :对 4 5例安置心房按需起搏器 (AAI)及房室顺序起搏器 (DDD)的病窦综合征房颤患者进行了平均 3.3年的随访观察。结果 :4 5例病窦患者仅 1例出现房颤 (2 .2 % )。对 5个典型病例进行分析的结果提示 ,超速持续心房起搏可以抑制病窦患者房颤的发生。结论 :心脏起搏抑制房颤发生的机制可能与快频率起搏加速心房内传导、抑制了房性期前收缩、消除了窦性心动过缓和心脏长 短间歇有关。双心房或AA起搏方式可能是一种比较理想的预防房颤的方法     

双腔起搏器置入患者术后心房颤动的发生情况及相关因素分析

目的分析因病态窦房结综合征(病窦)或高度房室传导阻滞置入双腔起搏器患者心房颤动(房颤)及无症状房颤的发生情况及其相关影响因素。方法选择因病窦及高度房室传导阻滞首次置入双腔起搏器的患者515例,其中病窦组221例,其中房颤106例,非房颤115例;房室传导阻滞组294例,其中房颤103例,非房颤191例。以起搏器置入指征、是否发生房颤及房颤发生时有无症状,分别比较患者的临床资料、房颤及无症状房颤的发生情况及影响因素。结果 515例患者中,房颤发生率为40.6%。房室传导阻滞组心室起搏、左心室舒张末内径较病窦组明显升高(P0.01)。房颤患者年龄、冠心病、心房起搏、左心房内径较非房颤患者明显升高(P0.05,P0.01)。无症状房颤患者年龄、冠心病和心室起搏较症状房颤患者明显升高(P0.05,P0.01)。多因素logistic回归分析显示,年龄、心房起搏、胺碘酮药物史是房颤的危险因素;而年龄(OR=0.957,95%CI:0.925~0.990,P=0.011)、心室起搏(OR=0.982,95%CI:0.972~0.992,P=0.000)是无症状房颤的危险因素。结论起搏器可以连续有效的监测房颤发作,尤其是无症状房颤发作。     

起搏器置入术后并发房颤的危险因素研究进展

房颤(AF)是临床上最常见的心律失常之一。起搏器置入术后房颤的发生率高于普通人群,其中年龄、高血压、左心房扩大、窦房结综合征(SSS)、起搏模式、心房及心室起搏比例、起搏器置入方式等均是影响起搏器置入术后新发房颤的危险因素。本文针对上述因素影响房颤发生的机制作一综述,以期为临床提早预防房颤提供理论参考。     

生理起搏与心室起搏对中风和心血管原因死亡的作用

早期的起搏器治疗有症状的心动过缓只有心室起搏 ,近期的起搏器既可心房起搏又可心室起搏以获得房室同步起搏 (生理起搏 )。初步研究表明生理起搏可能优于心室起搏 ,生理起搏发生房颤、中风和死亡的危险低 ,但还未经大规模随机对照试验证实。在 32个加拿大中心 ,选择没有慢性房颤 ,因有症状的心动过缓行第一次安装起搏器的病人进入本试验。共 2 5 6 8例 ,随机分配病人分别接受心室起搏或生理起搏且平均随访 3年。第一观察结果是中风或心血管原因死亡。第二观察结果是任何原因的死亡、房颤和心衰住院率。1474人随机安置了心室起搏器 ,而 10 9…     

心房起搏比率对病态窦房结综合征患者起搏器术后心房颤动发生的影响

探索心房起搏比率对病态窦房结综合征(病窦综合征,SSS)患者起搏器术后心房颤动发生的影响。方法:选取2012年9月至2014年3月,因SSS于我院住院首次植入双腔起搏器,且术前无心房颤动病史的患者171例。术后1个月、3个月、6个月和1年分别进行程控随访获取心房起搏比率(the percentage of atrial pacing,AP%)、心室起搏比率(the percentage of ventrivular pacing,VP%)、心房高频事件(atrial high rate events,AHRE)发作日期和时长等参数。心房颤动定义为患者有>5min的AHRE。根据首次检测到AHRE时之前的累积心房起搏比率将患者分为三组:低心房起搏比率组(AP%<30%,n=75)、中心房起搏比率组(30%≤AP%<60%,n=54)和高心房起搏比率组(AP%≥60%,n=42)组。比较三组间一般情况、并存疾病、左心房增大、心室起搏比率和心房颤动发生率。结果:三组间在性别、年龄、高血压、糖尿病、高脂血症、冠心病、脑梗死、左心房增大、心室起搏比率方面差异无统计学意义(P>0.05),但心房颤动的发生率差异具有统计学意义(P<0.01);事件曲线显示三组心房颤动发生率的不同,且差异具有统计学意义(P<0.05);多因素Logistic回归分析显示:心房起搏比率(AP%)≥60%(OR:4.62,95%CI:1.65~12.97,P=0.004),高血压(OR:4.03,95%CI:1.32~12.34,P=0.015)、左心房增大(OR:5.79,95%CI:2.07~16.19,P=0.001)是SSS患者起搏器术后心房颤动发生的独立危险因素。结论:心房起搏比率与SSS患者起搏器术后心房颤动的发生率相关,AP%≥60%、高血压、左心房增大,是SSS患者起搏器术后心房颤动的独立危险因素。     

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。     

心脏双腔起搏器植入术后新发心房颤动的相关危险因素分析

目的探讨无心房颤动(房颤)病史患者在双腔起搏器植入术后新发房颤的危险因素及其联合模型的预测价值。方法本研究为单中心回顾性研究。收集2019年1月1日至2021年3月31日于江苏省苏北人民医院心血管内科首次植入心脏双腔起搏器治疗患者的资料, 根据是否发生房颤分为新发房颤组和无房颤组。比较和分析两组患者术前基线资料(包括年龄、性别及烟酒史等)和随访资料(包括起搏模式、起搏比例及植入后用药)等, 筛选独立危险因素并建立联合预测模型。结果入选223例患者, 年龄(70.23±8.88)岁, 其中男113例, 随访(17.94±9.05)个月。①起搏器植入术后新发房颤45例(20%, 45/223), 包括症状性房颤21例(47%, 21/45)和心房高频事件(AHRE)24例(53%, 24/45), AHRE中亚临床房颤(SCAF)10例(42%, 10/24)。②新发房颤组与无房颤组患者在糖尿病病史、饮酒史、尿酸水平、左心房内径、左心室射血分数、房性早搏百分数、平均心率及最快心率、心室起搏百分数、起搏模式、β受体阻滞剂使用率上差异有统计学意义(P<0.05)。③将性别、年龄、体重指数...     

Influence of Cardiac Pacing Mode on Left Atrial Appendage Flow Velocity: Implication to Systemic Embolism During VVI Pacing

Previous studies have shown that the incidence of thromboembolism is higher in patients with single-chamber ventricular demand (VVI) pacemakers than in patients with dual-chamber (DDD) pacemakers. However, data on left atrial appendage flow velocity in pacing patients are limited. To investigate the influence of the pacing mode on the left atrial appendage flow velocity, we studied 19 patients with permanent DDD pacemakers and measured the left atrial appendage flow velocity by transesophageal echocardiography at baseline (during DDD pacing) and after switching to VVI pacing. The indications for pacemaker implantation were second- and third-degree atrioventricular block (AVB group, n = 11) and sick sinus syndrome (SSS group, n = 8). Compared with the DDD pacing mode, there was a significant decrease in the left atrial appendage flow velocity during VVI pacing in both the SSS group (43 ± 14 vs 23 ± 7 cm / sec, P < 0.05) and the AVB group (59 ± 18 vs 41 ± 18 cm / sec, P < 0.05). In eight patients with persistent retrograde ventriculoatrial conduction during VVI pacing, the left atrial appendage flow velocity was markedly decreased (from 43 ± 16 to 25 ± 9 cm / sec, P < 0.05). In five (63%) of the eight patients, left atrial appendage flow velocity was less than 25 cm/sec. A reduction in left atrial appendage flow velocity when switching from DDD to VVI pacing may account for an increased risk of thrombus formation in the left atrial appendage (an increased thromboembolic risk in patients in sinus rhythm with VVI pacemakers).     

Atrial Sensing and AV Synchrony in Single Lead VDD Pacemakers: A Prospective Comparison to DDD Devices with Bipolar Atrial Leads

INTRODUCTION: Single lead VDD pacing has offered an alternative to DDD systems in patients with isolated AV block. Up to now, however, the relative performance of these pacemaker systems was not systematically compared. METHODS AND RESULTS: Three hundred sixty patients who received either a VDD pacemaker (n = 180) or a DDD device (n = 180) with a bipolar atrial lead were investigated prospectively for a mean period of 30 +/- 13 months. Pacemaker function was analyzed by telemetry, Holter monitoring, and exercise ECG. Time of implantation and fluoroscopy was significantly lower with VDD devices (44.3 +/- 5.1 min vs 74.4 +/- 13.5 min and 4.6 +/- 2.5 min vs 10.3 +/- 5.6 min in DDD pacemakers, respectively). Intermittent atrial undersensing occurred in 23.3% of patients with a VDD pacemaker and in 9.4% with DDD devices (NS). The incidence of atrial tachyarrhythmias did not differ between the VDD (6.7%) and the DDD group (6.1%). Sinus node dysfunction developed in 1.9% of patients, but the vast majority (85.7%) of patients were asymptomatic. There was a tendency for a higher rate of operative revisions in the DDD group (6.1% vs 3.3% in VDD pacemakers, P = 0.15). Cumulative maintenance of AV-synchronized pacing mode was 94.9% in patients with VDD pacemakers and 92.1% with DDD devices (NS). CONCLUSION: With the benefit of a simpler implant procedure, long-term outcome of single lead VDD pacing is equivalent to DDD pacing in patients with AV block and preoperative normal sinus node function.     

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。     

Comparison of atrial and VVI pacing modes in symptomatic sinus node dysfunction without associated tachyarrhythmias

The natural course of patients with symptomatic sinus node dysfunction who did not have associated tachyarrhythmias before pacemaker implantation was compared after VVI and atrial pacemaker implantation. Between April 1981 and June 1989, forty-seven such patients (mean age 52 + 13 years) received VVI pacemakers and forty patients (mean age 54 + 13 years) received AAI or DDD pacemakers. Baseline clinical characteristics and severity of sinus node dysfunction were comparable in the two groups. Over a follow up of 10 to 96 months (mean 49.2 + 26 months), 11 (23.4%) VVI patients were in functional class II or more compared to 2 (5%) atrially paced patients (p less than 0.01). Other complication rates were also higher in the VVI group as compared to AAI group viz. atrial fibrillation (21.2% vs 2.5% p less than 0.01) and stroke (10.6% vs 2.5%) though the number of deaths (14.9% vs 10%) was not significantly different in the two groups. Two patients in atrial paced group and one patient in VVI group developed first degree heart block. There was no incidence of second or third degree heart block. Transient loss of atrial sensing occurred in 3 patients and atrial lead displacement in 2 cases, but overall incidence of lead related problems was low and comparable in both groups. Thus atrial pacing is superior to ventricular pacing in sinus node dysfunction and risk of developing high grade atrioventricular block on follow up is low.     

Arrhythmia in patients with a DDD bicameral pacemaker

Dual chamber pacemakers, with coordinate atrial and ventricular sensing and stimulation (DDD), even if allowing "physiological" pacing, exhibited new and complicated arrhythmic manifestations, whose real frequency is still unascertained. In 65 patients (mean age 68 +/- 12 years), implanted with a DDD multiprogrammable device (15 pts. Medtronic Versatrax 7000 A, 50 pts. Pacesetter AFP 283), we carried out a 24 hours Holter monitoring while pacemaker was programmed with standard parameters. In a subset of 15 patients Holter monitoring was performed before and after pacemaker implantation. We evidenced: a) atrial sensing and/or pacing malfunction in 3 patients (4.5%); b) pacer-unrelated arrhythmias in 49 patients (75%): atrial extra beats 35 patients (54%), ventricular extra beats 23 patients (35%), non-sustained ventricular tachycardias 10 patients (15%), atrial tachyarrhythmias 8 patients (12%); c) supraventricular arrhythmias with PM-mediated high rate ventricular pacing in 12 patients (18%); d) PM induced and sustained endless loop tachycardias in 31 patients (47%); e) arrhythmias depending on over-sensing in 11 patients (17%): myopotential interferences 9 patients (14%), cross-talk ventricular pacing inhibition 2 patients (3%). The prevalence of ventricular arrhythmias was not different before and after the pacemaker implantation. The prevalence of atrial extrasystoles (53% versus 40%) and atrial tachyarrhythmias (26% versus 6%) decreased after the pacemaker implantation. Aimed reprogramming with progressive extension of atrial refractory period (from 250 to 400 msec and DDX) achieved disappearance of PM-endless loop tachycardias in 95%. Use of multi-programmability lowered the incidence and symptoms of most PM-related arrhythmias. Drug therapy was of choice in clinical arrhythmias unrelated to pacer.     

双腔起搏器自动模式转换功能的临床应用

为观察双腔起搏器自动模式转换功能在房性心律失常治疗中的应用效果 ,对置入具自动模式转换功能起搏器的 31例患者分别于术后第 4天、1个月及每隔 3个月进行一次跟踪随访 ,观察房性心律失常的发生情况和起搏器自动模式转换情况及临床症状。全部病例随访 1～ 18个月 ,出现阵发性心房颤动、心房扑动及房性心动过速 76阵次 ,起搏器由DDD(R)自动转换成DDI(R)模式 72阵次 ,患者自觉心悸 8阵次。结论 :自动模式转换功能可使起搏器在患者发作房性心动过速时发挥对心室的保护作用 ,有效避免由于起搏器跟踪快速心房率而造成心室率过快引起的血流动力学改变 ,并能明显减轻心悸等临床症状 ,提高病人的舒适性和安全性。     

Pacemaker syndrome and retrograde ventriculoatrial conduction

19 cases of pacemaker syndrome were observed in 121 patients implanted with VVI pacemakers. The main manifestations of pacemaker syndrome were dizziness, lightheadedness, fatigue, hypotension and congestive cardiac failure after permanent ventricular pacing. The incidence of pacemaker syndrome was 20% in patients with sick sinus syndrome and 13.2% with A-V block. Pacemaker ECG showed retrograde ventriculoatrial conduction in 25 of 121 cases. Among these patients, 14 (56%) had pacemaker syndrome, while only 5 of 96 cases without ventriculoatrial conduction had this syndrome, so the incidence of the two groups were quite different, P less than 0.0001. The frequency of ventriculoatrial conduction in patients with sick sinus syndrome was higher than in patients with A-V block (16/45 vs 9/76, P less than 0.05). The electrophysiologic study were performed in 17 cases before PM implantation. 3 cases had 170-190 ms ventriculoatrial 1:1 conduction. Retrograde ventriculoatrial conduction in pacemaker ECG were present during ventricular pacing in all of them.     

Prevalence of atrial fibrillation and stroke in paced patients without prior atrial fibrillation: A prospective study

Background: Several reports suggest that the incidence of stroke and atrial fibrillation is reduced in patients receiving physiologic pacemakers, compared with patients receiving a ventricular pacemaker. Hypothesis: The study was undertaken to address the impact of different pacing modalities on the incidence of stroke and atrial fibrillation. Methods: We prospectively analyzed 210 consecutive patients. Those with previous episodes of cerebral ischemia and/ or atrial fibrillation were excluded from the study. The study population included 100 patients paced for total atrioventricular (AV) block or second-degree AV block (type II Mobitz) and 110 patients paced for sick sinus syndrome (SSS). The pacing mode was randomized. All patients underwent a brain computed tomography (CT) scan at the date of enrollment and after 1 and 2 years. Patients were followed for 2 years, and the incidence of atrial fibrillation and stroke was evaluated. Results: The incidence of atrial fibrillation was 10% at 1 year and 11% at 2 years. Comparing the different pacing modalities, we reported an increase in the incidence of atrial fibrillation in patients receiving ventricular pacing (p<0.05). On the other hand, no difference was found between patients paced for AV block and those paced for SSS. At the end of follow-up, we reported 29 cases of cerebral ischemia: 9 patients had AV block while 20 had SSS (p<0.05). Comparing the different pacing modalities, there was an increase in the incidence of stroke in patients receiving ventricular pacing (p< 0.05). Conclusion: There was an increase in the incidence of stroke and atrial fibrillation in patients with ventricular pacing.