心室按需起搏与房室顺序生理性起搏对过缓性心律失常患者远期疗效的比较

Comparison of long-term effects between VVI and DDD on patients with bradycardia arrhythmia

目的:观察心室按需起搏器(VVI)与房室顺序生理性起搏器(DDD)对过缓性心律失常治疗的远期疗效。方法:过缓性心律失常患者203例,按不同起搏方式分为心室按需起搏组(141例)与房室顺序生理性起搏组(62例)。研究终点:①在每次预定的随访中,以标准12导联心电图,动态心电图及心电监护诊断房颤;②卒中;③心力衰竭;④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,分析起搏和感知功能。每例患者至少有一份ECG,部分患者做Holter,了解有无术后阵发性及持续性房颤的发生,对已形成AF患者行心脏多普勒检查以了解有无左心房附壁血栓形成。结果:VVI组与DDD组比较,房颤发生率分别为47例(33.33%)与3例(4.84%),有显著统计学差异(P<0.05)。心衰发生率分别为17例(12.06%)和1例(1.62%),有显著统计学差异(P<0.05)。VVI组脑栓塞发生3例,DDD组无发生;VVI组死亡4例,DDD组死亡1例。结论:双腔起博(DDD)可有效减少房颤与心衰的发生。

Objective：To compare the clinical effects of using WI or DDD in patients with bradycardia arrhythmia. Methods ： 203 patients with bradycardia arrhythmia were divided into VVI（ n = 141）and DDD group（ n = 62）. Endpoint of this 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）heart failure; （4）cardiovascular death. Each patient was followed-up 1,3 and 6 months after discharged from the hospital for evaluating the effects. After that, the follow-up was carried out at interval of every half year. Also, ECG recording for each subject was kept, besides Holter and UCG, for comparing those with AF. Results ： The incidence of atrial fibrillation in VVI group was observed in 47 subjects（33.33% ） vs . 3（4.84% ） in DDD group, and 17 and 1 patients were complicated with heart failure in VVI group and DDD group, respectively, which was significantly different （ P 〈 0.05）. Stroke was found in 3 patients in VVI group, while it was not seen in DDD group. There were 4 deaths in VVI group and 1 death in DDD group. Conclusion： In bradycardia arrhythmia, dual-chamber pacing can effectively reduce the incidence of atrial fibrillation and heart failure.