自动模式转换起搏器对阵发性心房颤动检出的临床探讨

Clinical Approach of Detective Function for Paroxysmal Atrial Fibrillation by the Pacemaker With Automatic Mode Switch

了解运用自动模式转换 (AMS)起搏器的模式转换功能对阵发性心房颤动 (AF)检出效果。 17台 AMS功能起搏器参数设置 :上限频率为 90～ 110 bpm、心房检测频率 12 0～ 13 0 bpm、心房感知灵敏度 0 .65± 0 .19(0 .5～0 .75 ) m V、频率自适应 AV间期 3 0～ 2 0 0 ms、心室后心房不应期 (PVARP) 2 5 0～ 3 70 ms,打开 AMS功能。通过AMS监测、动态心电图及心电图随访 17例患者 (男 13例、女 4例 ,年龄 69± 12 .7岁 ) ,以了解 AF发作及模式转换情况。 15 17例患者 AF发作 5 4 5次 ,检出 5 4 4次 ,启动 AMS 5 4 4次 ,检测成功率为 99.9% ;1例患者动态心电图证实有 AF发作 ,但起搏器内无存贮的 AMS资料 ,检测失败率为 0 .1%。 1例检测到肌电位 4次 ,并启动 AMS功能 ,误检测率为 0 .73 %。 AF发作时检出的房率为 12 5～ 4 0 0 bpm。结论 :具有 AMS功能的起搏器对阵发性 AF检出可靠 ,适用于有 AF发作的慢 快综合征患者。但计时窗、心房感知灵敏性及 f波大小对 AF检出有重要影响。

To verify the effect of detective function for paroxysmal atrial fibrillation (PAF) by the pacemaker with automatic mode switch (AMS) function.The parameters setting of 17 pacemakers were upper rate 90～110 ppm,atrial detectable rate 120～130 bpm,atrial sensitivity 0.65±0.19(0.5～0.75) mV,adaptive AV delay 30～200 ms,post ventricular atrial refractory period 250～370 ms,function of AMS was on.In 17 cases (male 13,female 4,averagy age 69±12.7),the dates of atrial fibrillation (AF) episodes and mode switch function of pacemaker were recorded through the AMS monitor,dynamic electrocardiogram and ECG.15/17 cases had total 545 episodes of AF,544 episodes were detected by pacemakers,but AMS function were activated in 544 episodes.The detective rate was 99.9%.In one patient,episode of PAF was recorded in Holter monitoring,but no episode of PAF was stored in the pacemaker,detective failure was 0.1%.AMS were activated after detected 4 times of myopotentials by pacemaker,erroneous detective rate was 0.73%.Detected atrial rate were 125～400 bpm during PAF.Conclusion:Detective function for episodes of PAF is a reliable pacemaker with AMS function,this kind of pacemaker is more suitable for the bradytachycardia syndrome patients.In additions,timing cycle windows,atrial sensitivity and size of f waves play important roles for detection of PAF.