具有夺获控制功能的双腔起搏器临床应用

Preliminary experience on the clinical use of pacemaker with capture control function

目的 观察夺获控制功能对双腔起搏器工作电压和安全性的影响。方法 将 10例适合植入双腔起搏器的患者随机分为普通双腔组和夺获控制组 ,每组 5例 ,前者安装 Dromos DDDC普通双腔起搏器 ,后者安装 L ogos DDDC夺获控制型双腔起搏器 (均为德国 Biotronik公司产品 )。常规左锁骨下静脉穿刺植入起搏导线 ,脉冲发生器埋植在左前上胸壁。对夺获控制组除测定常规参数外 ,还在术中开启夺获控制功能并自动校正。两组患者在术后 2 4h、1周、1个月、3个月和 6个月随访 ,以动态心电图观察起搏效果 ,并对起搏器进行程控调整。结果 两组起搏器植入参数差别无显著性 ,随访期间均能安全起搏。术后 6个月夺获控制组心室常规工作电压明显低于普通起搏组。结论 (1)与普通双腔起搏器相比 ,夺获控制型双腔起搏器的临床安全性明显增加 ,能在非预期性或临时性起搏阈值增加时提供安全起搏。(2 )夺获控制型双腔起搏器的常规工作电压明显低于普通双腔起搏器。(3)由于夺获控制过程也是耗能的过程 ,故其对双腔起搏器工作寿命的净效应有待进一步评价。 (4)与美国 Pacesetter公司的自动阈值夺获起搏器 (Microny、Regency SC+/ SR+)相比 ,这种夺获控制功能存在如下缺点 :1不能自动测定起搏阈值和极化电位 ;

Objective To evaluate the effect of capture control function on programmed pacemaker output voltage and capture safety. Methods Ten patients were randomized into common DDD group and capture control group.Dromos DDDC and Logos DDDC(Biotronik Co.)were implanted respectively in these two groups.In addition to the regular test parameters,capture control function was calibrated in capture control group.All patients were followed up at 24 hours,1 week ,1 month,3 month and 6 month after pacemaker implantation. Results There were no difference in test parameters during operation between these two groups.All pacemakers worked well during follow up.The programmed working voltage in common DDD group was significantly higher than that in capture control group in the last follow up evaluation. Conclusions ①Capture control function makes this kind pacemaker significantly safer than common DDD pacemaker.②The programmed working voltage of capture control DDD pacemaker is significantly lower than that of the common DDD pacemaker.③Because the capture control is also an energy consumption process,the pure effect of this function on the pacemaker service time needs further evaluation.④Comparing with pacemaker with automatic threshold capture function such as Microny,Regency SC+/SR+(Pacesetter Co.),there are following shortcomings in these capture controlled pacemakers:①Real threshold and polarization potential can not be automatically measured.②The increase of the pacing voltage is not according to the measured threshold,but to the programmed voltage.③For the detected ineffective pulse,remedy pulse would not be delivered until next stimulus.