一种新的双腔起搏模式——AAISafeR与DDD模式的对比临床研究

A clinical comparison between a new dual-chamber pacing mode-AAISafeR and DDD mode

目的评价存在自身房室传导置入双腔起搏器的患者,分别以DDD模式和AAISafeR模式工作3个月后心室起搏百分比以及临床指标。方法因病窦综合征置入Ela Symphony D 2450 DR2550系列双腔起搏器的患者30例,随机分为两组DDD组和AAISafeR组,3个月后交叉程控为AAISafeR和DDD,再随访3个月。结果没有观察到与AAISafeR有关的不良反应;AAISafeR模式能显著降低心室起搏的百分比51.3%(2%～91%)与0.9%(0～3%),(P=0.001);2.94%(0～18%)与41.18%(0～65%),(P=0.000);DDD模式工作3个月,左房直径、左室舒张末径、左室收缩末径均比术前增加,左室射血分数降低,差异有显著性,AAI SafeR模式工作3个月,除左房内径明显增大外,其余指标无明显改变;30例患者,在6个月的随访中,21例因不同程度的房室传导阻滞,AAI模式暂时转换为DDD模式。结论AAISafeR起搏模式能够有效降低心室起搏的百分比;AAISafeR起搏模式能够在出现房室传导阻滞的情况下,迅速安全的转换为DDD模式。

Objective To compare cross follow-up results between DDD and AAISafeR mode,and to describe the safety and effectiveness of this pacing mode. Methods The Symphony 2450/2550 cardiac pacemakers were implanted in 30 patients with sick sinus syndrome. They were randomized to the DDD mode or AAISafeR mode for three months and then crossed over to the alternate pacing modality for an additional three months. Results No AAISafeR-related adverse e- vents were observed. All documented episodes of paroxysmal atrioventricular block caused the immediate switch of the pa- cing mode from AAI to DDD. The cumulative percent of ventricular pacing was significantly reduced in the AAISafeR mode compared to the DDDmode [0.9%（0-3%） vs51.3%（2% -91%）,P=0.001;2.94%（0-18%） vs41.18%（0- 65% ） , P =0. 000） ]. After 3 months with DDD mode,left atrial diameter,left ventricular end-diastolic diameter and left ventricular end-systolic diameter increased significantly while left ventricular ejection fraction decreased. However, no obvious changes appeared in 3-months of AAISafeR mode. Switches to DDD occurred during follow-up in 21 patients due to different degree AV block. Conclusion The AAISafeR mode substantially reduces the amount of unnecessary right ventricular pacing in the bradycardia population and effectively prevents the negative effects on cardiac performance.