VVI与DDD起搏对病窦综合征患者远期疗效的比较

Clinical Effect of Different Pacing Mode on Patients With Sick Sinus Syndrome.

比较VVI与 DDD起搏方式对病窦综合征患者的临床疗效.研究病窦综合征患者212例,按不同起搏方式分为两组:VVI组105例、DDD组107例.研究终点:①在每次预定的随访中,以标准12导联ECG、Holter及心电监护诊断心房颤动(简称房颤);②卒中:当患者有大于24 h脑缺血事件而产生神经系统症状或24 h内死于脑血管事件,可确诊为卒中;③死亡:心血管事件死亡.患者出院后1,3,6个月定期随访,以后每隔半年随访一次.随访时,记录标准12导联ECG存档.每例患者至少有一份ECG,部分患者做Holter,了解有无阵发性房颤及术后发生持续性房颤的时间,患者的症状及体征.结果:①与VVI组比较,DDD组房颤发生率明显降低(10.3% vs 24.8%,P＜0.05);②VVI组患者6例出现脑卒中(5.7%),而DDD组无1人发生脑卒中,两组差异有显著性(P＜0.05);③VVI组共有3例在术后3,4年发生慢性充血性心力衰竭,最后死于恶性心律失常,而DDD组患者均无因心力衰竭住院,随访至今无死亡.DDD组11例房颤均在2年内发生,其中第1年7例,而VVI组有26例房颤发生的时间较为弥散,2年内发生8例(30.8%),其余在3～8年内陆续发生.结论:病窦综合征患者安装双腔起搏器治疗发生房颤和脑卒中的机率明显减少.

Effect of single-chamber （VVI） and dual-chamber （DDD） pacing modes on patients with sick sinus syndrome （SSS） was assessed. A retrospective study was taken in 212 patients with SSS who were eligible to receive the treatment with one of modes of pacemaker： VVI（ n = 105） and DDD（ n = 107）. Endpoint of study included （1）that 12-lead ECG and Holter at every follow-up were performed to diagnose onset of atrial fibrillation （AF） ;（2）stroke;（3）cardiovascular death;（4） time easy to provoke the onset of AF. Results： The incidence of AF and stroke differed significantly between VVI （24. 8%, 5.7% ） and DDD groups （ 10.3%, 0% ）. Congestive heart failure was seen in three patients in VVI pacing mode during 3 and 4 years of post-implantation. Eventually three patients died from malignant cardiac arrhythmia. But no hospitalization from heart failure and no death were seen in DDD group. AF took place consecutively in all 11 patients in DDD group during 2 years , but it happened in different time in 26 patients in VVI group （30% of AF within 2 years, nearly 70% of AF within 3-8 years）. Conclusion： In sinus node dysfunction, dual-chamber pacing reduces the incidence of atrial fibrillation and stroke, but does not change the rates of cardiovascular death and hospitalization for heart failure, as compared with ventricular pacing. [ Chinese Journal of Cardiac Pacing and Electrophysiology ,2005,19 （5） ：353 - 355 ]