306例患者不同心脏起搏模式影响的回顾性分析

Influences of different modes of pacing on heart function:Retrospective analysis of 306 patients

目的心脏起搏器广泛运用于治疗缓慢性心律失常,但不同起搏模式对心功能的影响不同。文中旨在回顾性分析不同起搏模式对左心重构以及心血管事件发生率的影响。方法比较AAI、VVI、DDD 3种起搏模式前后患者的心电图、心脏超声、临床症状、体征的变化,以及相关心血管事件发生率。结果 AAI组患者植入前后的左心房收缩末期直径(left atrial end-systolic dimension,LAESD)、左心室舒张末期直径(left ventricular end-diastolic dimension,LVEDD)变化无统计学意义,发生的心血管事件较少;而VVI、DDD组患者植入后LAESD、LVEDD大于植入前水平,且相关心血管事件也较多,但这2组之间未见有统计学差异。按起搏适应证分类,传导阻滞组的LAESD、LVEDD变化及相关心血管事件的发生率高于病态窦房结综合征(sick sinus syndrome,SSS)及心房纤颤(简称房颤)伴长间歇组;在VVI组起搏的患者,术前发生房颤与未发生房颤的患者长期随访比较未发现LAESD、LVEDD的变化有统计学意义。结论 AAI起搏模式在对患者左心重构以及心血管事件的影响方面优于VVI、DDD。VVI、DDD起搏模式对患者左心重构以及相关的心血管事件的不良影响主要与心室起搏有关。

Objective Cardiac-pacemaker therapy is widely applied in the treatment of various types of bradycardia,but different modes of pacing have different influences on the heart function.This presents a retrospective analysis on the influences of different modes of pacing on left heart remodeling and cardiovascular events.Methods We compared the electrocardiograms,ultrasound cardiograms,clinical symptoms,physical signs and relevant cardiovascular events of the patients before and after the application of the three modes of pacing-AAI,VVI and DDD.Results The AAI group showed no statistically significant differences in the left end-systolic dimension（LAESD） and left ventricular end-diastolic dimension（LVEDD） and few cardiovascular events before and after the implantation of the pacemaker,while the VVI and DDD groups exhibited larger LAESD and LVEDD and more cardiovascular events after the implantation than before it,but with no significant differences.Based on the indications,more LAESD and LVEDD changes and cardiovascular events were observed in patients with atrial ventricular block than in those with sick sinus syndrome and those with atrial fibrillation companied by long intermittence.In the VVI group,long-term follow-up revealed no significant changes in LAESD and LVEDD in the patients with or without atrial fibrillation before the implantation of the pacemaker.Conclusion AAI is better than VVI and DDD as regards their influence on left heart remodeling and cardiovascular events,and the adverse effects of the latter two modes are mainly associated with ventricular pacing.