房间隔起搏对病窦综合征并阵发性心房颤动的影响

目的探讨房间隔起搏(ASP)对病窦综合征(SSS)合并阵发性心房颤动(PAF)的影响。方法 12例SSS合并PAF行DDD(房间隔部)起搏,术前查常规心电图、24h动态心电图(DCG)及超声心动图,测量最长P波时限(Pmax)、最短P波时限(Pmin),计算P波离散度(Pd),观察PAF发作例数、发作次数及持续时间,测量左房直径等,术后1周内、3个月及1年时复查心电图、DCG及超声心动图,并统计起搏心搏比例。结果与起搏前窦性心律心电图比较,ASP后1年内Pmax和Pd均较术前明显缩短(P均0.05)。ASP1周内,PAF发作例数、发作次数及持续时间明显减少(P均0.05);但随着时间延长,PAF发作例数、发作次数及持续时间有增多趋势;术后发现再发心房颤动者均有基础病,且已转变为持续心房颤动者心房直径明显大于非持续心房颤动及窦性心律者,但与起搏心搏比例无关;术后左房直径有缩小趋势。结论 ASP能明显缩短Pmax及Pd,可以预防和治疗PAF,降低PAF的发生率,但有基础心脏病、心房直径增大者远期疗效不佳。

The influence of atrial septal pacing therapy on the incidence of paroxysmal of atrial fibrillation with sick sinus syndrome

Objective To investigate the clinical effect of paroxysmal atrial fibrillation（PAF） with sick sinus syndrome （SSS） in atrial septal pacing（ASP） patients. Methods DDD pacemaker in atrial septum were implanted in twelve paitents of PAF with SSS. Twenty-four hours dynamic electrocardiogram （DCG） and routine electrocardiogram were recorded and two-dimensional echocardiography were evaluated. P wave maximum （Pmax） and P wave duration （Pd） were measured. The episode cases, the arrays, and the persistence time of PAF in these patients were observed before pacemaker implant. These parameters were rechecked in a week and 3 months and a year after pacemarker implanting. And ratioes of cardiac pacing were calculated. Results The Pmax and Pd were shorter significantly during ASP than those during sinus rhythm（ P 〈 0.05）. The episode cases and the frequencies and the persistence time of PAF decreased markly, after a week of postopration, but followed the prolonging time, they would increase. The cardiac atrium diameter and heart disease were strongly associated with atrial fibrillation, but there was no relationship with ratioes of cardiac pacing; ASP decreased the left atrial dimension but with no significant differences. Conclusions ASP can shorten Pmax and Pd obviously, which can prevent and treat occurrences of PAF, but long-term therapeutic effect in patients with larger cardiac atrium diameter and heart disease is poor possibly.