心房起搏脉冲传导延迟患者AV间期的优化

Optimaization of AV interval in patients with atrial pacing impulse conduction delay

目的探讨心房起搏至心房除极波时间延迟患者设置起搏的房室间期（PAV）的方法及远期心房起搏的有效性。方法分析2005年1月至2012年12月我院起搏器植入后发生心房起搏至心房除极波时间延迟≥lOOms的患者10例，病窦综合征（SSS）患者的房室间期设置为最大值，并最大限度开启房室问期滞后功能；对房室传导阻滞（AVB）患者设置PAV的值为：140～180ms＋心房起搏至心房除极波延迟时间，不开启AV滞后。结果经1个月至7年随访，5例SSS患者心室起搏比例〈10％，3例SSS患者心室起搏比例30％。50％，Holter显示心室起搏时为假性融合波，l例SSS患者及1例AVB患者为心室起搏心律，起搏比例〉99％，保证了房室问期的生理性。10例患者心房起搏阈值均〈1．5／0．4ms，未发生心房起搏阈值增高及失夺获。结论心房起搏至心房除极波时间延迟患者远期的心房起搏夺获是安全的；设置起搏器PAV间期要将心房起搏至心房除极波延迟时间计算其中，程控随访中应注意观察程控仪中监护图的心房波，房室传导阻滞患者可延长房室间期后观察心房波，部分患者因监护导联显示不清，需要通过12导联心电图进行观察，避免心房起搏至心房除极波延迟病例被遗漏．导致增加心室起搏及非生理性的房室间期。

Objective To investigate the forward effectiveness of atrial pacing and methods of setting atrioventricular delay in the bases of atrial pacing to depolarization wave. Methods We analysed ten patients whose atrial pacing to atrial depolarization wave delay was 〉 lOOms from January. 2005 to December 2012. We set the maximum atrioventrieular delay for patients with sick sinus syndrom and made the best use of atrioventrieu｜ar interval （AVD） hysterisis fimetitm. Then, PAV value of patients with atrioventricular block （AVB） was set as 140 to 180ms ＋ atrial pacing to atrial depolarization wave delay, and closed the AV hysteresis. Results After 1 month to 7 years follow-up, ventricular pacing ratio of five patients with SSS was 〈10%, and other three patients with SSS was 30% 50%, three cases of ECG showed pseudo-ventricular fusion wave, one case of SSS and another case of AVB were totally ventricular pacing rhythm, ventricular pacing ratio〉99%, ensuring physiological atrioventricular interval. All the atrial pacing thresholds were less than 1.5V/0.4 ms, and there＇ s no increase of atrial pacing thresholds and loss of capture. Conclusion The long-term atrial pacing is safe of patients with atrial pacing to atrial depolarization wave delay. Atrial pacing to atrial depolarization wave delay should be calculated in PAV interval. We should pay attention to atrial wave showed in progrannner, and observe atrial wave after prolonging AVD as to patients with AVB. Some patients need 12-lead ECG because of unclear ECG of programmer to avoid missing atrial pacing to atrial depolarization wave delay, which can result in the increase ratio of ventricular pacing and non-physiological atrioventricular interval.