心脏起搏患者无症状性心房颤动的检出及美托洛尔干预

The incidences of asymptomatic atrial fibrillation and effects of metoprlol in the patients with pacemakers

目的研究置入双腔心脏永久起搏器患者中心房颤动(简称房颤)和无症状性房颤的发生率及美托洛尔干预效果。方法 65例置入心脏起搏器的患者,分别于术后6个月(服药前),术后1年(每日口服琥珀酸美托洛尔缓释片47.5 mg,6个月后)进行随访程控起搏器,记录发生房颤例数、无症状性房颤例数、起搏器自动模式转换次数、房颤负荷,比较病窦综合征(SSS)组(n=31)和房室传导阻滞(AVB)组(n=34)组间及组内各参数。结果SSS组1例因发作持续性房颤而退出本研究。术后6个月SSS组11例(36.7%)出现房颤,其中无症状性房颤5例(45.5%);服药后6个月6例(20.0%)出现房颤,无症状性房颤3例(50%)。AVB组术后6个月8例(23.5%)出现房颤,无症状性房颤4例(50.0%);服药后6个月5例(14.7%)出现房颤,无症状性房颤3例(60%)。服药前两组房颤发生率及房颤负荷无明显差异(χ2=1.32,t=0.11,P>0.05)。两组患者服药后模式转换次数、房颤负荷明显减少(P均<0.05)。结论双腔永久心脏起搏器置入患者术后房颤和无症状性房颤发生并不少见;口服美托洛尔治疗可以降低房颤负荷,减少房颤的发生。

Objective To explore the incidences of asymptomatic atrial fibrillation（AF） and the effects of Metoprlol in the patients with dual chamber pacemakers. Methods Sixty-five patients with pacemakers were followed-up at 6 month, and 12 month（at 6 months after taking Metoprolol） after implantation. Pacemakers could record the incidences of AF, the numbers of mode switch, AF burden. Then, above parameters were compared in sick sinus syndrome （SSS）group （n = 31 ） and in atrioventricular block（AVB） group（n= 34）. Results In SSS group, one patient was rejected because of persis- tent AF, 11 of the 30 patients （36.7 % ） had AF at 6 months after operation, and 5 patients （45.5%） with asymptomatic AF. 6 patients （20.0%）had AF at 6 months after taking metoprlol, and 3 patients （50%）with asymptomatic AF. In AVB group at 8 patients（23.5% ） had AF in 6 months,and 4 patients with asymptomatic AF （50.0%）. 5 patients（ 14.7% ） had AF at 6 months after taking metoprlol, and 3 patients with asymptomatic AF（60% ）. The incidences of AF and AF burden in the SSS group had no statistical significance before taking medicine compared with those in AVB grouP（X2 = 1.32 ,t=0. 11 ,P〉 0. 05）. The numbers of mode switch and AF burden had statistical significance between the two groups （P〈0. 05）. Con- clusion The incidences of AF and asymptomatic AF after operation were not uncommon in the patients with dual chamber pacemakers. Taking metoprolol can depress AF burden, reduce the incidences of AF.