采用特殊起搏程序治疗病窦综合征伴阵发性心房颤动的近期疗效

The short-term efficacy of the patients with sick sinus syndrome and paroxysmal atrial fibrillation by special modes of pacing therapies.

目的评价具有预防心房颤动(AF)功能的特殊起搏程序治疗病窦综合征(SSS)伴阵发性AF(PAF)的近期疗效。方法34例置入DDDR起搏器(Vitatron900E和9000型)SSS伴PAF患者分3阶段治疗。第1阶段(4周):监测记录房性快速性心律失常;第2阶段(4周):根据第1阶段获悉AF触发因素启动相关具有预防AF功能的特殊起搏程序。第3阶段(4周):特殊起搏程序启动同时给予抗AF药物治疗。观察比较各阶段AF情况。结果34例手术全部成功,4例未记录到PAF的发生,余30例均发生PAF,其中突然发作8例,房性早搏触发AF20例,运动后心率突然减慢而触发AF2例。特殊程序抗AF治疗14例显著有效,11例有效,5例无效,无恶化发生;第2阶段与第1阶段比较,每天AF发作次数、发作总时间及单次最长发作时间明显减少(P<0.01),第3阶段与第2阶段比较,AF发作总时间及单次最长发作时间明显减少(P<0.01),但每天发作次数无明显变化(P>0.05)。结论VitatronSelection900E和9000起搏器具有较准确的监测PAF功能,心房超速起搏及特殊起搏方式对PAF发生具有一定疗效和耐受性,伴PAF的SSS患者可采用预防AF起搏程序功能起搏同时配合抗AF药物的综合性治疗。

Objective To evaluate the efficacy of special modes of pacing therapies on the patients with sick sinus syn- drome（SSS） and paroxysmal atrial fibrillation（PAF）. Methods Vitatron Selection 900E or 9000 dual chamber cardiac pacemakers were implanted in 34 patients with SSS and PAF. Early Follow-up was divided into 3 stages：Monitoring stage, pacing therapies with special modes, and pacing therapies combined with medications, and AF burden was compared in different stage. Results Pacemakers were successfully performed in 34 patients. PAF occurred in 30 patients during stage one and no PAF in 4 patients. PAF episodes interrelated with premature atrial contrations in 20 patients,without premature atrial contractions in 8 patients. Rate decreased prior to PAF onset in 2 patients. Pacing therapies with special modes were observed to be significantly effective in 14 patients, somewhat effective in 11 patients, ineffective in 5 patients, and no exacerbation was observed to be during stage two. Pacing therapies combined with medications were observed to be effective in 30 patients. The number of PAF episode, total duration of PAF episodes, and the longest duration per PAF were less during stage two than those during stage one（P 〈0. 01 ）. Total duration of PAF episodes and the longest duration per PAF were less during stage three than stage two（P 〈 0. 01 ）, but the number of PAF episodes was not significant （P 〉 0.05 ）. Conclttslon Vitatron Selection 900E and 9000 hold the functions of monitoring PAF exactly, and special modes of pacing therapies on the patients with SSS and PAF are effective therapy, especially combined with medications.