起搏方式对病态窦房结综合征患者的随访研究

Clinical studies of pacing mode on patients with sick sinus syndrome

目的比较AAI起搏器与DDD起搏器不同的起搏方式对病态窦房结综合征（SSS）患者预后的长期影响。方法86例因SSS植入起搏器的患者，按不同起搏方式分为两组，AAI起搏组32例，DDD起搏组54例。植入术后随访内容包括起搏器程控，患者的症状、体征，心电图或动态心电图，超声心动图及心功能。研究终点（1）心房颤动的发生率；（2）脑卒中的发生率；（3）心功能分级及超声心动图检查指标。结果随访20—80（4-2．1±15．7）个月，（1）DDD组心房颤动（房颤）发生率明显高于AAI组（P〈0．05）；（2）脑卒中发生率差异无统计学意义（P〉0．05）；（3）左心房内径、左心室舒张末期内径和左心室射血分数在AAI组植入前后差异无统计学意义（P〉0．05），而DDD组术后左心房内径、左心室舒张末期内径增大，左心室射血分数下降（P〈0．05）；（4）AAI组与DDD组比较，对心功能影响较小。结论与DDD起搏方式比较，AAI起搏方式房颤发生率低，对心功能影响小。

Objective To compare the long term effect of AAI and DDD pacing in patients with sick sinus syndrome （SSS）. Methods A total of 86 consecutive patients were randomized to one of mode of pace- maker：AAI（n =32） or DDD （n =54）. Endpoint of study included （ 1 ） the incidence of atrial fibrillation （AF）. （2） the incidences of stroke. （3） NYHA cardiac function class, changes in left atrial （LA） and left ventricular end-diastolic （LVED） diameters, and left ventricular ejection fraction （LVEF） measured by echo- cardiography. Results （ 1 ） AF was significantly less common in the AAI group than in DDD group （ P 〈 O. 05）. （2） There was no significant difference in the incidence of stroke between the AAI group and DDD group （ P 〉 O. 05 ） . （ 3 ） In the AAI group, no significant changes were observed in LA diameter or LVED or LVEF from baseline to last follow-up （ P 〉 O. 05）. In the DDD group, LA diameter and LVED increased signif- icantly （ P 〈 O. 05 ）, while LVEF decreased significantly （ P 〈 O. 05 ）. （ 4 ） Compared with DDD group, AAI group had less effect on cardiac function. Conclusion Compared with DDD group, AAI pacing mode is less prevalence of AF and accepted cardiac function than DDD pacing mode.