心室起搏管理对病态窦房结综合征患者心功能的影响

目的：观察心室起搏管理（managed ventricular pacing,MVP）对病态窦房结综合征（sick sinus syndrome,SSS）患者心功能的影响.方法：42例植入具有MVP功能的双腔起搏器（Medtronic Adapta ADD01/ADDR01/ADDRL1）的SSS患者,先以双腔起搏（DDD/R）模式工作6个月,再程控为MVP模式工作6个月,统计两种模式下右心室起搏比例,并比较两种模式下患者心功能的变化.结果：在DDD/R模式下,平均右心室心尖部起搏比例达43.6％,左心室射血分数（left ventricular ejection fraction,LVEF）从（56.5±2.6）％下降至（54.1±3.0）％（P=0.001）,左心室舒张末期直径（left ventricular end-diastolic diameter,LVEDD）从（49.6±2.6）mm升高至（51.4±2.4）mm（P=0.002）,B型利钠肽（B-type natriuretic peptide,BNP）从（77.0±16.2） pg/mL升高至（87.2±16.4） pg/mL（P=0.032）.在MVP模式下,平均右心室心尖部起搏比例仅为1.8％,LVEF从（54.1±3.0）％上升至（55.4±1.4）％（P=0.042）,LVEDD从（51.4±2.4）mm下降至（50.2±2.0）mm（P=0.016）,BNP从（87.2±16.4） pg/mL下降至（86.5±14.9） pg/mL（P=0.852）.另外,DDD/R模式下有4例患者发生阵发性心房颤动,而MVP模式下仅1例发生阵发性心房颤动,但差异无统计学意义（P=0.180）.结论：与DDD/R模式比较,MVP模式能显著减少右心室起搏比例,且对心功能有较好的保护作用.

Effect of Managed Ventricular Pacing on Heart Function in Patients with Sick Sinus Syndrome

Objective：To study the effect of managed ventricular pacing（MVP） on heart function in patients with sick sinus syndrome（SSS）.Methods：Pacemakers with MVP algorithm were implanted in 42 patients with SSS.Conventional DDD/R mode had been programmed in the first 6 months,and then MVP algorithm had been programmed in the next 6 months.Right ventricular pacing proportions were calculated,and the heart function changes were compared between the two modes during 6 month follow-up.Results：During DDD/R mode,the mean value of cumulative right ventricular pacing proportion was 43.6％;left ventricular ejection fraction（LVEF） decreased from（56.5-± 2.6） ％ to （54.1 ± 3.0） ％ （P =0.001） ; left ventricular enddiastolic diameter（LVEDD） increased from（49.6-± 2.6）mm to （51.4 ± 2.4）mm（P =0.002） ; B-type natriuretic peptide（BNP）increased from （77.0 ± 16.2） pg/mL to （87.2 ± 16.4）pg/mL（P =0.032）.During MVP algorithm,the mean value of cumulative right ventricular pacing proportion was 1.8％; LVEF increased from （54.1 ± 3.0）％ to （55.4 ± 1.4）％ （P =0.042）;LVEDD decreased from （51.4 ± 2.4）mm to （50.2-± 2.0）mm（P =0.016） ; BNP decreased from （87.2 ± 16.4） pg/mL to （86.5± 14.9）pg/mL（P =0.852）.In addition,paroxysmal atrial fibrillation was found in 4 cases in the DDD/R mode,and 1 case in the MVP algorithm（P =0.180）.Conclusions：Compared with conventional DDD/R mode,MVP algorithm significantly reduces the cumulative right ventricular pacing proportion,and it can protect heart function better.