DDD起搏器植入后不同患者的动态心电图的表现及其临床意义

目的探讨DDD起搏器植入术后传导阻滞及窦房结功能不良不同患者的动态心电图（DCG）表现及临床意义.方法采用12通道DCG分析系统对157例患者进行监测分析,根据起搏器治疗适应症分为2组：A组传导阻滞组68例;B组窦房结功能不良组89例,分析判断比较2组患者DDD起搏器的DCG表现、主要工作模式、感知起搏功能异常、与起搏器相关的心律失常及自身心律失常;计算起搏心博数/总心搏数.结果 （1）2组患者起搏比例≥60%的检出率均明显多于起搏比例〈60%的人数,P〈0.05;（2）DDD主要起搏类型：A组工作模式以VDD/VAT为主,其次为DDI,B组工作模式以DDI为主,其次为AAI,VDD/VAT发生最少.VDD/VAT工作模式A组高于B组,而AAI工作模式仅发生在B组,2组比较,差异有统计学意义（P〈0.01）;（3）157例共检出感知异常47例（29.94%）,起搏异常5例（3.18%）;（4）心室安全起搏检出率B组（22.47%）高于A组（10.29%）,P〈0.05;（5）与起搏器相关的心律失常：起搏介导性心动过速（PMT）、感知房性心动过速（AT）触发快速心室起搏B组（12.36%、21.35%）高于A组（2.94%、17.56%）,P〈0.05;（6）频发房性早搏及AT的发生率B组（22.47%、38.21%）高于A组（2.94%、17.64%）,P〈0.01,0.05.结论 DCG的各种表现可识别不同患者DDD起搏器植入后相应的主要工作模式,全面了解起搏器的工作状态,为起搏器的合理程控及自身心律失常的治疗等提供重要且准确的依据.

Clinical Significance of Dynamic Electrocardiogram Monitoring in Patients after Implantation of DDD Pacemaker

Objective To explore the dynamic electrocardiogram （DCG） manifestations and clinical significance in patients after DDD pacemaker implantation. Methods 157 cases of pacemaker patients were monitored by 12-channel DCG Analysis System. They were divided into two groups according to the indications of Pacemaker therapy： group A （68 cases, conduction block） and group B （89 cases, sinus node dysfunction） . Work mode, sensing and pacing abnormalities, and pacemaker related arrhythmia were analyzed. Then make diagnosis for atrial and ventricular arrhythmia and to calculate the ratio of pacemaker number and total quantity of heart beats. Results （1） The detection rate of pacemaker number/total number I〉60% in two groups was significantly higher than pacemaker number/total number of heart beats 〈60% （P 〈 0.05） （2） The main work mode of pacemaker：group A was VDD/VAT, followed by of DDI, group B was DDI, followed by AAI, the third was VDD/VAT. Work mode of VDD/VAT in group A was more than group B, and AAI only occurred in group B （P 〈 0.001） （3） Among 157 cases, abnormal perception was found in 47 cases （29.94%）, abnormal pacing 5 cases （3.18%） （4） The detection rate of safe ventricular pacing in group B （22.47%） were significantly higher than group A （10.29%） （P 〈 0.05） （5） Pacemaker-related arrhythmias： Pacemaker mediated tachyeardia （PMT） and Rapid ventricular pacemaking triggered were higher than group A （2.94% and 17.56%） by atrial tachycrdia （AT） in group B （12.36% and 21.35%） （P 〈0.05） （6） Frequent atrial premature beats and AT in group B （22.47% and 38.21% ） were significantly higher than group A （2.94% and 17.64% ） （P 〈 0.01, 0.05） . Gonclusions DCG monitoring can judging the major work mode and comprehensively learn the pacemaker working state in patients after DDD pacemaker implantatio. It will provide important and accurate reference for the clinician in pacemaker programming process.