中老年起博器植入患者的动态心电图分析

目的探讨动态心电图（DCG）监测对起搏器起搏及感知功能异常的诊断价值。方法采用美国惠普43400B型DCG分析系统,对95例年龄在50岁以上植入起搏器的患者进行随访,分析起搏、感知功能及与起搏器相关的心律失常并与常规心电图对照。结果共检出起搏器功能障碍23例,其中间歇性起搏功能障碍2例（占2%）,间歇性感知功能障碍21例（占22%）。检出与起搏器相关的心律失常17例（18%）。而常规心电图仅发现感知功能障碍2例。两种检查方式在检测间歇性感知功能障碍及与起搏器相关的心律失常方面存在显著性差异（P<0.01）。检出起搏功能异常的差异性未达到显著水平。DCG对3种类型（AAI、VVI、DDD）之间感知功能异常检出率无显著性差异。根据DCG结果,进行临床相应处理后,起搏器的起搏及部分感知功能障碍消失,相关心律失常引起的临床症状逐渐消失。结论起搏器的起搏、感知功能障碍及与起搏器相关的心律失常多为间歇性发生,DCG对其检出率较高,并可系统了解起博器工作状态及各种心律失常,是对起博器随访的重要手段之一。

Analysis of dynamic electrocardiogram in middle-age and elderly patients with pacemaker

AIM To evaluate the dynamic electrocardiogram(DCG) in detecting pacing or sensing abnormalities of pacemaker in the middle-aged and elderly patients.METHODS A total of 95 patients aged more than 50 years with pacemaker were examined by a HP 43400B dynamic electrocardiogram and the results were compared with those by a routine ECG.Pacing or sensing abnormalities and pacemaker-related arrhythmias were analyzed.RESULTS Sensing and pacing abnormalities were found by DCG in 23 cases,including 2 cases(2%) of intermittent pacing abnormalities and 21 cases(22%) of intermittent sensing abnormalities.Seventeen cases(18%) of pacemaker-related arrhythmias were detected by DCG while only 2 cases(2%) of intermittent sensing abnormalities were detected by the routine ECG.DCG had higher sensitivity than ECG in detecting intermittent sensing abnormalities and pacemaker-related arrhythmia(P<0.01), but no significant difference was found in detecting intermittent pacing abnormalities compared with ECG.No significant difference was observed in the sensitivities of detecting sensing abnormalities of AAI,VVI or DDD by DCG.All pacing abnormalities and partial sensing abnormalities disappeared following replacing pacemaker or adjusting the corresponding parameters of the pacemakers according to the DCG results.CONCLUSION The pacing or sensing abnormalities of pacemaker and pacemaker-related arrhythmia occur intermittently.The DCG shows high sensitivity in detecting of pacing or sensing abnormalities of pacemaker and provides important information on pacemaker function and arrhythmias.It is an important examination in follow-up of pacemaker.