双腔频率应答起搏对病窦综合征合并的阵发性心房颤动的干预

探讨双腔频率应答起搏对病窦综合征(SSS)合并的阵发性心房颤动(简称房颤)的窦性心律维持及电生理干预。48例SSS并阵发性房颤患者安装了双腔频率应答起搏器,通过起搏器正确的心房感知监测房颤的发作情况,在窦性心律时测量P波时限和P波离散度,心脏B超测量左房内径、左室射血分数。比较术后1,12个月以及房颤控制组与复发组上述指标的差异。结果:置入起搏器术后1年,房颤控制和房颤负荷减少37例,占77%。术后1个月与1年左房内径,P波时限,房颤平均每天发作时间、发作次数均有显著性差异(3.6±0.6cmvs3.2±0.5cm,129.2±11.0msvs111.2±9.3ms,93.6±10.4min/dvs42.8±9.6min/d,8.1±3.2次/天vs5.3±1.4次/天,P<0.001)。与术后房颤复发组比较,房颤控制组术前左房内径较小,P波时限较短、离散度小(P<0.001)。结论:双腔频率应答起搏对SSS合并的阵发性房颤有预防和治疗作用。

Effects of Dual-Chamber Rate-Responsed Pacemarker on Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome

To explore the effect of dual-chamber rate-responesed pacemarker on paroxysmal atrial fibrillation(PAF) in patients with sick sinus syndrome(SSS). DDDR pacemarkers were implanted in 48 patients with SSS accompanying PAF.PAF episodes were assessed by programmed atrial sensing.P wave duration and dispersion were determined during sinus rhythm and left atrial diameter(LAD)and left ventricular ejection fraction were measured by doppler echocardiography.Results:At the one year follow-up after DDDR pacemarker,PAF disappeared or decreased in 37 patients(77%),LAD,P wave duration,PAF duration and times significantly reduced at the one year fllow-up compared to at the one month fllow-up(3.2±0.5 cm vs 3.6±0.6 cm,111.2±9.3 ms vs 129.2±11.0 ms,42.8±9.6 min/d vs 93.6±10.4 min/d,5.3±1.4 times/d vs 8.1±3.2 times/d,all P<0.001).Before DDDR pacemarker implanted,LAD and P wave dispersion were smaller,P duration was shorter in PAF control group than those in PAF reoccurrence group(P<0.001).Conclusion:Dual-chamber rate-responsed pacemarkers have a preventive and therapeutic effect on PAF in the patients with SSS.