双腔起搏器自动房室间期搜索功能的临床应用观察

The Clinical Observation of Auto AV Search Algorithm in Dual Chamber Pacemaker.

目的观察双腔起搏器自动AV间期搜索功能(auto AV search)减少心室起搏的有效性及对心功能和快速房性心律失常的影响。方法43例植入具有自动AV间期搜索功能的双腔DDD(R)起搏器的患者,术后6个月内随机交叉关闭或打开AV search功能各3个月,分别在第一阶段(3个月末)、第二阶段(6个月末)程控获取心室起搏百分比(Vp)、高频心房事件及测试血浆BNP值。结果43例患者按计划完成随访,AV search关闭组心室起搏(VP)比例为78.0±10.3%,心房高频事件为58±15次,血浆脑钠肽(BNP)水平为333±30pg/ml;AVsearch打开组Vp比例为15.9±4.8%,心房高频事件为29±13次,BNP65±21 pg/ml,两者相比具有显著统计学差异(P<0.01)。结论双腔起搏器的auto AV search功能可有效减少非必须的心室起搏,促进自身心室激动。

Objective To observe the effect of reducing ventrieular pacing and rapid atrial arrhythmia with the auto AV search algorithm. Methods 43 Patients implanted with Medtronic kappa 700/900 DDD（R） pacemaker were randomized to the auto AV search algorithm or DDD/R mode for 3 month and then crossed over to the alternate pacing modality for additional 3 months. On the completing date of the crossover phase, the percent of ventricular pacing, atrial high frequence event and plasma BNP level were recorded during the first period and the second period of follow-up visits. Results 43 patients successfully completed the crossover study. Compared with the DDD/R mode, the cumulative percent of ventricular pacing, the atrial high frequence event and plasma BNP level were all significantly reduced in the auto AV search algorithm（ 15.9 ± 4.8 % Vs 78.0 ± 10.3 %, 29 ± 13 vs 58 ± 15 and 65 ± 21 pg/ml vs 333 ± 30pg/ml, respectively. P 〈 0.01 ）. Conclusions The Search AV algorithm in the pacemaker effectively promotes intrinsic ventricular activation and substantially reduces unnecessary ventricular pacing.