闭环式情绪体动双项感知频率适应性起搏器的临床应用

Clinical Application of Dual-Sensor Rate-Adaptive Pacemaker

目的 :频率适应性起搏器临床应用的主要类型是感知体动 ,但存在局限性。本组使用感知情绪、体动变化的闭环式频率适应性起搏器 ,可同时感知情绪及体动变化 ,相应增加或减少起搏心率 ,满足机体需求。 方法 :患者 10例 ,全部为窦房结功能障碍者 ,置入双腔闭环式频率适应性起搏器 (Biotronik INOS2 CL S)。起搏器机制为情绪激动或体动增加时 ,心肌收缩力及心肌阻抗明显增加 ,心室电极能感知局部心肌阻抗的变化 ,反馈增加或减少起搏心率。本组病例术后 8～ 9天、3个月、6个月分别随访做情绪紧张、步行运动及情绪紧张 +步行运动实验。 结果 :起搏器传感器对交感神经兴奋及步行体动反馈均敏感 ,两者相加无超敏感现象。本组较单体动起搏器组起搏心率明显增加。 结论 :闭环式情绪、体动双项感知频率适应性起搏器是一种感知情绪、体动变化反应好 ,更接近人体生理的心脏起搏器。

Objective:Activity sensing rate adaptive pacemaker is the primary type in clinical practice.It is somewhat limited.We used emotion and activity dual sensor rate adaptive pacemaker to modulate pacing frequency in response to the changes of emotion physiological and activity of the patients. Method:Biotronik INOS 2 CLS dual chamber closed loop rate adaptive pacemaker was implanted in 10 patients sufferring from sinus malfunction.The mechanism might be that emotional stimulation and increased activity made myocardial impedance increased,and the ventricular electrode could detect the changes and increased pacing feed back.Emotional stress test,walking test and emotion and treadmill stress test were performed 1 week,3 months and 6 months after implantation respectively. Results:Pacemaker sensor was sensitive both to the sympathetic stimulation and walking.No oversensing events were found. Conclusions:Closed loop emotion and activity dual sensor rate adaptive pacemaker can detect changes of emotion and activity at the same time and make instant rection.It is safe and closer to the physiological process.