生理性起搏器治疗缓慢型心律失常的临床观察

The clinical effect of physiological pacing in 85 patients with bradyarrhythmia

目的探讨生理性起搏器在缓慢型心律失常中的临床疗效与安全性。方法共85例患者，起搏器包括双腔起搏器DDD[心房＋心室（起搏心腔）；心房＋心室（感知心腔）；双重（1抑制＋T触发）（感知后反应方式）]60例，双腔起搏器VDD[心室（起搏心腔）；心房＋心室（感知心腔）；双重（1抑制＋T触发）（感知后反应方式）]3例，双腔起搏器VVIR[心房＋心室（起搏心腔）；心房＋心室（感知心腔）十（1抑制）（感知后反应方式）；R频率调整（程控功能）]22例。结果85例患者均手术成功，术中测得心室起搏阈值为（0．42±0．13）V／0．5ms，阻抗（560±130）Ω，R波振幅（9．8±2．2）mV；右心房起搏阈值为（0．89±0．27）V／0．5ms，阻抗（670±180）Ω，P波振幅（2．8±1．2）mV，P波感知灵敏度（0．48±0．3）mV。A—V间期程控在140-160ms，频率适应参数程控为反应时间和恢复时间取中档值，增益取低档值，下限频率程控为60-70次／min，上限频率程控于110-130次／min，感知阈值取中档，频率适应档次取4～5。随访4-50个月，所有患者的生活质量明显提高，无起搏器并发症发生。结论生理性起搏可产生较好的血液动力学效应，改善心功能，提高运动耐量，对有适应证的起搏器患者应首先推荐使用各类生理性起搏器。

Objective To evaluate the clinical effect of physiological pacing in bradyarrhythmias.Methods 885 patients were planted with physiological pacemaker, including 60 cases with DDD, 3 cases with VDD, 22 cases with VVIR and 1 case with three chamber biatrial pacemaker. The electrode leads were positioned through subclavian vein. Results The pacing threshold of right ventrieular leads were （0.42±0.13）V,the resistence were （560±130）Ω and the amplitude of R wave were （9.8±2.2）mV.The pacing threshold of right atrial leads were （0.89± 0.27）V, the resistance were （670±180）Ω, the amplitude of P wave were （2.8＋1.2）mV.The AV intervals of dual chamber pacemakers were programmed from 140-160 ms. The rate-adaptive parameters were set at middle value. There were no complications. Conclusion Physiological pacing may improve the hemodynamic conditions and can be applied safely to patients with hradyarrhythmias.