具有自动阈值管理和房室搜索功能起搏器Enpulse的临床应用

Clinical application of Enpulse pacemaker with auto management capture and AV search.

目的动态观察具有自动阈值管理和房室搜索功能起搏器Enpulse的临床应用。方法76例患者植入了Enpulse系列起搏器,于植入时,植入后1,6个月采用手工测试心房、心室起搏阈值和阻抗并与心房、心室自动阈值管理(ACM、VCM)测定的值进行比较,并利用ACM、VCM进行术后阈值和阻抗的动态观察。计算术后心室起搏百分比,并与传统起搏器相比较。结果72例完成随访。手工测试的心房、心室阈值与ACM、VCM测定的无显著性差异。心房、心室起搏阈值均小于1 V,心房起搏阈值于植入1个月后有下降趋势,而阻抗未见有明显变化;心室起搏阈值无明显变化,但阻抗于植入2～6个月时有下降趋势。Enpulse起搏器的心室起搏比例为4.895%±9.0589%,明显小于传统起搏器(79.479%±16.159 3%,n=60)。结论Enpulse的自动阈值管理能自动测定阈值,并以较小的能量输出安全起搏,AV搜寻功能明显减少心室起搏比例。

Objective To observe the effect of Enpulse pacemaker which has the function of auto management capture and AV search. Methods Seventy-six patients were implanted Enpluse pacemaker. The thresholds and impedance of atrium and ventricle tested manually were compered with that tested by ACM and VCM at the time of implantation, 1 month and 6 months after implantation. Furthermore, the percentage of ventricular pacing of the Enpluse pacemaker was recorded and compared with that of the common pacemaker. Results Seventy-two patients finished the follow-up. There was no statistical significant difference in thresholds and impedances of atrium and ventricle between tested by ACM and VCM. The pacing thresholds of atrium and ventricle were less than 1 V. The thresholds of atrium started to descend at 1 month after operation, but the impedance of atrium had not redundant variance. The ventricular threshold had not redundant variance, but ventrleular impedance had inclined tendency in 2 to 6 month after operation. The Enpulse dual chamber pacemaker obviously descended the rate of ventricle pacing while compared with common dual chamber pacemaker（4. 895% ±9. 058 7% vs 79. 479%± 16. 159 3% ,n =60）. Conclusion Testing the threshold and reducing the energy output antomatically by using ACM and VCM are effective and safe in Enpulse pacemaker. And the function of AV search can decrease the percentage of ventricular pacing significantly. [ Chinese Journal of Cardiac Pacing and Electrophysiology ,2009,23 （5） ：402 -404 ]