生理性心脏起搏的选择及应用限制的探讨

１２１例安置生理性心脏起搏器的患者，完全性及高度房室传导阻滞４２例；病窦综合征７９例，其中窦性心动过缓、窦性停搏６０例、慢─快综合征１９例。安置ＤＤＤ起搏器４０例，２８例为心房变时性反应正常的完全性房室传导阻滞。安置ＡＡＩ、ＡＡＩＲ（变时性反应不良者选用）起搏器４９例。发生并发症１４例，均为采用心房电极起搏方式者。其中电极脱位３例、低感知４例、膈刺激现象及输出阻滞各２例、起搏器介导性心动过速３例，根据笔者的经验，对不同心律失常类型提出了选择生理性起搏方式的原则，并就其应用限制进行了讨论，强调全面评估病情是作出最佳选择的前提。

Selection and Limitations of Physiological Pacing

One hundred and twenty-one patients with symptomatic bradycardia received the physiological pacemaker implantation. 42 of them were complete and high degree A-V conduction block and 79 were sick sinus syndrome(60 patients with sinus bradycardia and sinus arrest and 19 cases with brady-tachycardia syndrome).40 patients received DDD pacemakers,28 of them were complete A-V conduction block and normal atrial chronotropic response. 49 patients received AAI and AAIR(for cases with chronotropic incompetence) pecemakers. A total of 14 complications developed only in those used atrial electrodes. Atrial lead displacement, atrial undersensing, diaphragm stimulation, exit block and pacemaker mediated tachycardia occurred in 3,4,2,2, 3 respectively. According to authors's experience, the principle of selecting optimal pacing mode in patients with different arrhythmias was put forward,meanwhile some limitations of physiological pacemaker were discussed. Author emphasizes that the comprehensive consideration of patients's conditions is prerequisite for selection of optimal physiological pacing mode.