病态窦房结综合征P波变异与心房颤动的关系

The relationship between atrial fibrillation and P wave changes by atrial pacing in sick sinus syndrome

目的研究病态窦房结综合征(病窦综合征)患者右心耳起搏后P波变异和临床预测心房颤动的危险因素。方法病窦综合征患者76例,Ⅰ组植入房室顺序起搏器(fully automatic dual chamber pacing, DDD),再分为Ⅰa组(术后无心房颤动)和Ⅰb组(术后有心房颤动);Ⅱ组植入双心房(biatrial synchronous triggered pacing,DDTA)或双心室三腔起搏器(cardiac resychronization therapy pacing,CRT)。自身心率时P波间期和起搏心率时P波间期从标准12导联心电图测量,心房颤动发生根据24 h动态心电图记录,随访时间(17±14)个月。结果右心耳起搏后Ⅰb组起搏P波宽度比自身P波增宽,差异有统计学意义(P< 0．05);右心耳起搏后,P波宽度等于或超出130 ms患者的心房颤动事件发生率高于P波宽度小于130 ms患者,Ⅱ组心房颤动发生率为24％,较Ⅰ组(47％)减少;在心室起搏心率大于或等于50％时,Ⅰ组术后阵发性心房颤动发生率(39％)明显高于Ⅱ组(20％)。结论DDD起搏后P波宽度延长可导致阵发性心房颤动发生率增加,自身P波宽度等于或超出130 ms的患者,术后心房颤动发生率高。DDTA或CRT同步起搏时阵发性心房颤动发生率比DDD起搏减少。

Objectives To investigate both the clinical significance of atrial fibrillation （AF） before right atrial appendage （RAA） pacing and the influence of prolonged P wave on AF occurrence in RAA-paced patients with sick sinus syndrome （SSS）. Methods Seventy-six patients （age 63.92±9.34 years; 40 men, 36 women） with SSS undergone RAA pacing were divided into 2 groups：51 patients after DDD pacing （Ⅰ） and 25 patients after DDTA or CRT pacing（Ⅱ）. Group Ⅰ was further subdivided into 2 groups： 27 patients without AF after pacing （Ⅰa） and 24 patients with AF after pacing（Ⅰb）. Duration of the follow up was （17±14） months. Results AF recurrence was significantly higher in group Ⅰ than in group Ⅱ. The duration of RAA pacing in leads was significantly greater than intrinsic P wave in group Ⅰb （0.103±0.018 vs 0.137±0.017, P〈0.05）. Conclusions SSS with AF before pacing caused a significant intra-atrial conduction disturbance and a high incidence of AF recurrence after implantation of RAA pacing, especially in patients with a prolonged paced P wave （P wave〉130 ms）, in whom new pacing modalities may be needed to shorten paced P wave or improved heart function during and prevent AF.