心房颤动发作时心房电极的置入

Atrial lead implantation during atrial fibrillation attack

目的:探讨心脏起搏器置入术中心房颤动(房颤)发作时置入心房电极的方法和可靠性。方法:对24例具有心脏起搏器安置指征的慢快综合征患者房颤发作时置入心房电极的方法、术中术后心房电极的参数进行分析。结果:所有病例全部成功置入心房电极。4例阵发性心房扑动(房扑)患者经超速刺激转复2例;普罗帕酮转复8例阵发性房颤、房扑患者4例成功,胺碘酮转复14例阵发性房颤患者6例成功,总转复率45%。12例术后复律后程控测得P波振幅、心房电极阻抗、起搏阈值与12例术中复律患者测得的参数差异无统计学意义(P>0.05);10例房颤患者术中测得心房波为(0.8±0.6)mV,明显小于术后复律后程控测得的P波(1.4±0.5)mV(P<0.05),但两者阻抗无明显差别(P>0.05)。结论:心脏起搏器置入术中房颤发作时置入心房电极安全可靠。

Objective：To evaluate the efficacy and safety of atrial lead implantation during atrial fibrillation attack.Method：The ways for proper atrial leads implantation during atrial fibrillation attack were studied and the parameters of the atrial leads during and after operation were analysed in 24 patients who suffered from slow-fast syndrome and were suitable for cardiac pacemaker and atrial lead implantation.Result：Atrial leads were implanted successfully in all patients.Two of 4 patients with atrial flutter patients were cardioverted by overdrive suppression.Four of 8 patients with atrial fullter and atrial fibrillation were cardioverted with propafenone and 6 of 14 patients with amiodarone.The total cardiovertion rate was 45%.The P amplitude,resistance,pace threshod of atrial lead measured under sinus rhythm after operation were no different with those measured under sinus rhythm during operation（P0.05）.The atrial amplitude（0.8±0.6 mV）measured during operation while atrial fibrillation attack was less than that（1.4±0.5 mV）under sinus rhythm after operation（P0.05）,but there was no difference about the resistance of atrial leads（P0.05）.Conclusion：Atrial lead implantation during atrial fibrillation attack is feasible and safety in the patients who need DDD pacemaker.