心房按需起搏的临床应用

AAI起搏是治疗房室传导正常的病态窦房结综合征(SSS)的理想方法,它可保持正常的房室收缩顺序及防止VVI起搏时心房压力上升,对预防心房纤颤(Af)有一定作用。本组17例AAI起搏主要用于房室传导正常的SSS,其中4例合并间断发作的Af,1例合并阵发性室上性心动过速(PSVT)。在随诊观察1～15个月之间,Af未再发作,PSVT也得到控制。本组17例全都采用螺旋形主动电极。我们体会其优点为电极可固定在心房之任何部位,操作简单,不易移位,采用可程控多参数的SSI型起搏器,便于定期进行心房调搏,观察房室传导功能的变化及处理可能发生的感知障碍及输出阻滞。

Clinical Application of Atrial demand Pacing

Atrial pacing has the advantages of simplicity, maintenance of AV synchrony, and normal hemodynamics. The major detraction has been the potential for deterioration of atrioventricular conduction. In this study, we followed 17 patients with sick sinus syndrome with normal AV conduction treated with atrial (AAI) pacing. Serew-in active endocardial leads were used in all of 17 caces and excellent initial implant parameters were obtained. The stimulation threshold varied from 0.7V to 1.8V (Pulse duration of 0.5ms) with a mean of 1.3±0.3V. P-wave amplitude ransed from 2.0mV to 5.0mV with a mean of 3.2±1.2mV, the lead impedance varied from 536 ohms to 1167 ohams with a mean of 892±293 ohms. There was no lead dislocation. Minor sensing and pacing problems could all be handled by reprosramming. Followup for a mean of 4 months demonstrated excellent performance of the pacing system. In the 4 cases, the paroxysmal atrial fibrillation was controlled by AAI pacing. The results showed that the AAI pacing in the selected patients was safe and reliable with good chronic lead performance and low risk of subsequent conduction system disturbance.