双房同步起搏技术的临床应用

Clinical Application of Biatrial Synchronic Pacing Techniques

双房同步起搏是恢复双房电活动同步化的一种新的起搏技术，可防治快速房性心律紊乱。笔者对１７例房内、房间传导阻滞并快速房性心律失常患者进行双房同步起搏治疗，１４例行三腔起搏（ＤＤＤ）、３例行双房起搏（ＡＡＩ），冠状静脉窦电极均经左锁骨下静脉途径放置。起搏器及电极导线均顺利植入，未发现脱位、穿孔等并发症。冠状静脉窦电极导线顶端电极测定的Ｐ波振幅为５．６９±２．６３（２．４～９．６）ｍＶ、起搏阻抗６５５±１９４．１１（５２０～９６０）Ω、单极起搏阈值０．９２±０．６８（０．４～２．２）Ｖ。冠状静脉窦电极位置较深，则测得起搏阈值较低。随访８．６（３～１５）个月，１例猝死、１６例健在；其预防心房扑动、颤动的显效率达６２．５％、有效率达８１．２５％。结论：双房同步起搏技术是房间传导阻滞合并房性心动过速，心房扑动、颤动的有效治疗和预防方法。

Biatrial synchronic pacing is a new kind of pacing technology which can restore the synchrony of electrical activities in both the two atrium,can treat and prevent atrial tachycardia effectively.Biatrial synchronic pacing was performed in 17 cases of patients with the interatrial or intraatrial block and atrial tachycardia:trichamber pacing (DDD) in 14 cases of patients while bichamber pacing (AAI) in 3 cases of patients.Coronary sinus leads were inserted through the left subclarian veins.The complication of dislocation and perforation were not found.The amplitude of A wave,the impedance and the unipolar pacing threshold determined on the tip of the sinus leads were 5.692.63,655194.11 and 0.920.68,respectively.The deeper were the coronary sinus leads,the lower the pacing threshold. One patient was sudden death while other 16 patients were alive during 8.6 (315) months followup.Our study showes that the partial effective rate of prevention of atrial flutter or fibrillation is 62.5% while the total effective rate is 81.5%.Conclusion:Biatrial synchronic pacing is a effective method to treat and prevent atrial tachycardial,atrial flutter or fibrillation and interatrial block.