起搏器植入术后有症状患者起搏参数优化和程控

目的:回顾性分析心脏起搏器植入术后有症状患者的起搏参数优化和程控。方法:门诊随访患者324例,随访时根据患者向医生陈述的痛苦表现,如心悸、胸闷等症状,判定为有症状患者138例,其中双腔起搏器(dualchamber pacemaker,DDD)54例,单腔起搏器(singal-chamber pacemaker,VVI)84例。随访时间为术后当天至16年不等,根据患者的主诉、心电图及起搏器功能检测情况进行参数优化和调整,必要时行X胸片、动态心电图、心脏超声等检查。结果:在有症状患者中,共检出心房起搏障碍9例(DDD 9例)心房感知障碍2例(DDD 2例);心室起搏障碍13例(DDD 3例,VVI 10例);心室感知障碍12例(DDD 5例,VVI 7例);不适合工作状态31例(DDD 28例,VVI 3例);房性心律失常50例;室性心律失常12例;三度房室传导阻滞2例,长R-R间期3例。结论:起搏器植入后需定期随访,通过对其参数的测试、调整和优化,既能有效保障患者安全、延长起搏器电池寿命,还能最大限度地避免和减少患者临床症状的产生,使患者最大获益。

Parameter optimization and adjustment in pacemaker-implanted patients with clinical symptoms

AIM：To explore the parameter optimization and adjustment in pacemaker-implanted patients with clinical symptoms. METHODS： According to the patients’ complaints such as palpitations, chest tightness and other symptoms, 138 cases were deemed as patients with clinical symptoms among the 324 pacemaker-implanted patients followed in the Outpatient Department. Of the 138 patients, 54 were implanted with dual-chamber pacemakers （DDD） and 84 with single-chamber pacemakers （VVI）. Follow-up time varied from 1 day to 16 years after implantation. Based on the patients’ complaints, electrocardiographic （ECG） and pacemaker test results, we optimized or adjusted the parameters of the implanted pacemakers. Chest x-ray, dynamic electrocardiography （DCG） and ultrasound cardiography were performed when necessary. RESULTS： In patients with DDD, atrial pacing abnormalities were found in nine cases, ventricular pacing abnormalities in three cases, atrial sensing abnormalities in two cases, ventricular sensing abnormalities in five cases, and inappropriate working status in 28 cases. In patients with VVI, ventricular pacing abnormalities were found in ten cases, ventricular sensing abnormalities in seven cases and inappropriate working status in three cases. Altogether, atrial arrhythmia was found in 45 cases, ventricular arrhythmias in 12 cases, 3rd-degree atrioventricular block in two cases and long period R-R in three cases. CONCLUSION： Adjustment and optimization of the parameters of implanted pacemakers during the regular follow-up after pacemaker implantation can effectively ensure the safety of patients and prolong the battery life of the pacemakers, thus minimizing the patients＇ clinical symptoms.