346例心脏永久起搏器植入患者不同起搏方式随访分析

The long term following analysis of pacing modes in 346 patients implanted with permanent cardiac pacemakers

目的旨在比较心脏永久起搏器植入患者AAI,DDD及VVI3种起搏方式对长期预后的影响。方法346例因病窦综合征及Ⅲ°房室传导阻滞植入永久起搏器的患者,按不同起搏方式分为3组:VVI组136例、AAI组90例、DDD组120例,术后随访内容包括患者症状、体征、起搏器程控、及心功能分级(NYHA)。主要终点为心房颤动发生率,次要终点为脑卒中发生率,心功能分级及超声心动图指标。结果随访35.6±15.7个月,(1)AAI组房颤发生率明显低于DDD组及VVI组(8.89%vs20.83%vs23.53%,P<0.05),而DDD组房颤发生率与VVI组相比(20.83%vs23.53%,P>0.05)差异无显著性。(2)脑卒中发生率AAI组低于DDD及VVI组(2.22%vs6.67%vs7.35%,P<0.05),差异有显著性。而VVI组与DDD组脑卒中发生率(6.67%vs7.35%,P>0.05)无差异。(3)心功能的影响;DDD组及VVI组患者比AAI组患者各级心功能不全程度有增加,差异有显著性P<0.05,(4)超声心动图指标,随访结束时AAI组分别与DDD组及VVI组相比,左心房内径(LA)、左心室舒张末期内径(LVED)及左心室射血分数(LVEF)的差异有显著性P<0.05。而DDD组与VVI组相比,上述各指标差异均无显著性P>0.05。结论AAI起搏为较理想的起搏方式,可使患者最大获益,DDD起搏患者应尽量延长AV间期(A-Vdelay),或选择带AV间期滞后搜索(A-Vsearch)功能的起搏器,尽量保持自身下传,减少心室起搏。

Objective To evaluate the long term effects of AAI,DDD and VVI pacing on cardiac function and occurrence of atrial fibrillation in patients with sick sinus syndrome （SSS） and atrioventrilar block （AVB）. Methods Patients with SSS and AVB who were implanted with pacemakers were enrolled. AAI pacing（n=90）,DDD pacing （n= 120）or VVI pacing（n= 136） were due to mode of pacing. Pacemaker interrogation, electrocardiogram and echocardiography were performed during follow-up.The primary end point was occurrence of atrial fibrillation（AF）.The second end points were the incidence of stroke,New York Heart Association （NYHA） cardiac function class, changes of in left atrial（LA） and left ventricular end-diastolic （LVED） diameters, as well as left ventricular ejection fraction （LVEF） were measured by echocardiography. Results （1） AF was significantly less common in the AAI group than in DDD and VVI groups （8.89%vs20.83%vs23.53%,P〈0.05） . （2）The incidence of stroke was significantly less common in the AAI group than in DDD and VVI （2.22%vs6.67% ; vs7.35%,P〈0.05） . （3） In AAI group, no significant changes were observed in LA diameter, LVED or LVEF from baseline to last follow-up （P〈0.05） . In the DDD group ,LA diameter and LVED increased significantly （P〈0.05） while LVEF decreased significantly （P 〈 0.05） . （4） Compared with DDD group, AAI group had less effect on cardiac function. Conclusion In patients with sick sinus syndrome and atrioventrilar block,AAI pacing has less effect on cardiac physiology than DDD pacing,with less occurrence of AF.