不同起搏方式对病窦综合征患者远期效果的影响

Effects of Alternative Pacing Mode on Cardiac Function of Patients with Sick Sinus Syndrome

为了解不同起搏方式对病窦综合征特别是慢－快综合征患者心功能及房性心律失常的影响，利用超声心动图、体表心电图及Ｈｏｌｔｅｒ检查，对２１１例病窦综合征患者采用自身对照方法进行回顾性分析。结果发现：生理性起搏（ＡＡＩ／ＤＤＤ）组术后左室射血分数（ＬＶＥＦ）、心输出量（ＣＯ）明显增加（ＡＡＩ：５３．５±６．１％ｖｓ４７．２±７．８％，４．９５±０．５７Ｌ／ｍｉｎｖｓ４．２０±０．６２Ｌ／ｍｉｎ；ＤＤＤ：５２．５±６．８％ｖｓ４４．３±０．１％，５．１２±０．７１Ｌ／ｍｉｎｖｓ４．４１±０．３８Ｌ／ｍｉｎ；Ｐ均＜０．０１），左房内径（ＬＡＤ）无明显变化；ＤＤＤ组Ｅ／Ａ比值明显增加（０．９８±０．０９ｖｓ０．８７±０．１５，Ｐ＜０．０１），ＡＡＩ组Ｅ／Ａ比值呈增加趋势（Ｐ＝０．０５７）。房性心律失常发生率明显减少（１５．９％ｖｓ５０％，Ｐ＜０．０１）。非生理性起搏（ＶＶＩ）组术后ＬＶＥＦ、ＣＯ明显下降（４４．１±４．７％ｖｓ４８．３±４．３％，３．７７±０．４２Ｌ／ｍｉｎｖｓ４．１７±０．８５Ｌ／ｍｉｎ，Ｐ均＜０．０１），ＬＡＤ明显增大（３９．２６±２．３７ｍｍｖｓ３６．８１±２．３５ｍｍ，Ｐ＜０．０１），Ｅ／Ａ比值呈?

A retrospective analysis was made in 211 patients with sick sinus syndrome (SSS) by self control study.To assess the influence of alternative pacing mode on long term cardiac function and arrhythmia,several approaches including echocardiography,electrocardiogram (ECG) on torso surface and Holter were used.The results showed that:①The patients had higher left ventricular eject function (LVEF) and cardiac output (CO) after procedure of physiologic pacemaker implantation including AAI and DDD modes.The LVEF in group of AAI and DDD mode increased from 47.2 ±7.8 % to 53.5 ±6.1 % and from 44.3 ±0.1 % to 52.5±6.8% respectively ( P < 0.01 ).Likewise,the CO increased from 4.20±0.62 L/min to 4.95±0.57 L/min and from 4.41±0.38 L/min to 5.12±0.71 L/min respectively (P< 0.01 ).However,the left atrial diameter (LAD) had less change.The ratio of E/A increased obviously from 0.87±0.15 to 0.98±0.09 in DDD mode( P < 0.01 ) and was getting higher from 0.93±0.07 to 1.01±0.23 in AAI mode ( P =0.057).The incidence of atrial arrhythmia was much lower from 50% to 15.9%( P <0.01).② The group of patients with unphysiological pacemakers (VVI mode) had obviously decreased LVEF from 48.3 ±4.3 % to 44.1 ±4.7 % and CO from 4.17±0.85 L/min to 3.77±0.42 L/min,but more larger LAD from 36.81±2.35 mm to 39.26±2.37 mm( P <0.01).The ratio of E/A went down from 0.83±0.31 to 0.71±1.34.Although fewer atrial tachycardia happened than before,total incidence of atrial flutter and fibrillation increased from 49.6% to 56.6% ( P <0.05).Conclusion: Physiological pacemakers not only improved the long term cardiac function of patients with SSS,but also reduced atrial arrhythmia.Nevertheless,the patients with AAI pacemakers had no much better long term cardiac function than those with DDD pacemakers.