不同起搏模式心室起搏百分比与血浆脑钠肽水平的关系

Association between cumulative percent of ventricular pacing and plasma brain natriuretic peptide in patients of different pacing mode

目的观察患者置入具有工作模式转换功能的双腔起搏器术后心室起搏百分比与血浆脑钠肽(BNP)水平的关系。方法入选置入双腔起搏器的患者22例,采用自身前后交叉对照研究方法,观察同一患者在AAISafeR和DDD两种工作模式下的心室起搏百分比,通过酶联免疫吸附法检测患者血浆BNP水平,并分析两者之间的关系。结果与术前相比,所有患者血浆BNP水平术后均显著升高,与AAISafeR模式相比,DDD模式时患者血浆BNP水平明显升高,比较有统计学意义。与DDD模式比较,AAISafeR模式下心室感知百分比明显增加[(34.69±9.02)%vs.(73.18±13.08)%,P<0.05],心室起搏百分比明显减少[(73.24±11.38)%vs.(23.11±7.05)%,P<0.05],有统计学差异。相关分析显示,心室起搏百分比与血浆BNP水平显著正相关(r=0.157,P<0.001)。结论 AAISafeR模式可有效减少心室起搏百分比,心室起搏可能产生起搏依赖性的心功能损害。

Objective To investigate the association between cumulative percent of ventricular pacing(Cum%VP)and plasma brain natriuretic peptide(BNP)level in patients implanted double-chamber pacemaker.Methods To observe the Cum%VP with different pacing mode(DDD,AAISafeR)in 22 patients with single-blind,randomized and self-control principle.To measure the level of BNP by ELISA at each follow-up.Results The level of BNP statistically increased after pacemaker implantation compare with before implantation.Comparison with DDD mode,the cumulative percent of ventricular sensing in AAISafeR mode had significant increasing[(34.69±9.02)% vs.(73.18±13.08)%,P<0.05],the Cum%VP in AAISafeR mode had significant decreasing[(73.24±11.38)% vs.(23.11±7.05)%,P<0.05].The correlation analysis showed a positive correlation between Cum%VP and plasma BNP level(P=0.0003).Conclusions Cum%VP positively correlate with the plasma BNP level,which suggest increased cumulative ventricular pacing may exert adverse effect on heart function.