VVI与AAI起搏对病态窦房结综合征合并阵发性房性快速心律失常的影响

The effects of VVI and AAI pacing modes on paroxysmal atrial tachyarrhythmias of sick sinus syndrome

目的比较ＶＶＩ与ＡＡＩ起搏对病态窦房结综合征（病窦综合征）合并阵发性房性快速心律失常的远期影响。方法分别对４１和３８例病窦综合征合并阵发性房性心律失常的患者行ＶＶＩ和ＡＡＩ起搏，术后进行了临床、心电图、２４小时动态心电图的定期随访，随访时间分别为３９±２．６和２４±１．８个月。结果ＶＶＩ组２１例（５１．２％）发展成持续性心房颤动，２０例阵发性房性心律失常发作次数及持续时间较术前显著增加（Ｐ＜０．０５），６例（１４．１％）出现血栓栓塞，无１例死亡，无电极移位等并发症。ＡＡＩ组，所有患者生活质量明显改善，１９例（５０％）阵发性心房颤动、心房扑动发作的频度及持续时间较术前显著减少（Ｐ＜０．０５），无１例发展为持续性心房颤动、血栓栓塞和死亡，１例（３％）出现电极移位，１例（３％）出现一度房室阻滞。结论ＡＡＩ起搏是一种安全、可靠的起搏方式，对病窦综合征合并的阵发性房性心律失常有明显的抑制作用，显著优于ＶＶＩ。

bjective To compare the longterm effects of VVI and AAI pacing on paroxysmal atrial tachyarrhythmias of sick sinus syndrome(SSS). Methods A longterm followup survey was carried out in 41 cases of VVI pacing and 38 cases of AAI pacing by clinical examinations,electrocardiography(ECG) and dynamic ECG.The mean followup time was 3926 and 2418 months ,respectively. Results Among the VVI pacing group,21 cases developed sustained atrial fibrillation,in the other 20 cases the frequency and duration of episodes of paroxysmal atrial tachyarrhythmias were increased markedly than that before implantation(P<005)and evidence of systemic embolism was found in 6 patients.No death and lead dislocation occurred in this group.Among AAI pacing group,the paroxysmal atrial tachyarrhythmias were satisfactorily controlled in 19 cases,the frequency and duration of the atrial tachytachyarrhythmia episodes were decreased markedly than that before implantation(P<005)in the other 19 cases and no sustained atrial fibrillation,systemic embolism and death were found.Lead dislocation in 1(3%)patient,and first degree AV block in 1(3%)patient occurred in this group.The life quality of all patients in AAI group was improved significantly after pacemaker implantation. Conclusion AAI is a reliable and safe pacing mode which can inhibit paroxysmal atrial tachyarrhythmias of SSS and is apparently superior to VVI pacing.