肌电位干扰对复合双极心房感知与单极心房感知起搏器影响的临床观察

The clinical observation of the effects of myopotential interference on the combipolar atrial sensing system and unipolar atrial sensing system in DDD pacemaker

目的 观察肌电位干扰对复合双极心房感知与单极心房感知的双腔起搏器的不同影响及感知过度的发生率 ,分析两种起搏器不同的感知方式 ,提高对复合双极心房感知起搏器的认识。方法 对导线均经右侧植入的 30例复合双极心房感知和 30例单极心房感知双腔起搏器的患者进行随访 ,活动右上臂 ,行上肢等张运动时肌电位的干扰试验。结果 复合双极心房感知起搏器感知灵敏度 0 .5 m V时 ,无感知过度。单极心房感知起搏器感知灵敏度 1.0 m V时 ,感知过度发生率 2 1.7% ;0 .5 m V时 ,感知过度发生率 81.7% ,起搏器介入性心动过速发生率 5 0 %。 结论 与单极心房感知起搏器相比 ,复合双极心房感知起搏器具有更强的抗肌电位干扰能力 ,且导线使用寿命长 。

Objective The aim of this study is to evaluate the incidence rate of the oversensing and various effects of myopotential interference on different sensing mode [combipolar atrial sensing(CAS) and unipolar atrial sensing(USA)] in DDD pacemaker,so to improve the understanding of the combipolar atrial sensing system.Methods Myopotential interference tests were performed in 30 patients with CAS and 30 patients with UAS during right arm isotonic exercise,all leads were implanted via right subclavian vein.Results There were no oversensing events when combipolar atrial sensing sensitivity was 0.5 mV.The oversensing occurred in 81.7% and 21.7% when unipolar atrial sensitivity was programmed to 0.5 mV and 1.0mV respectively.Pacemaker mediated tachycardia occurred in 50% patients with unipolar atrial sensitivity of 0.5 mV.Conclusion Compared with unipolar atrial sensing system,the DDD pacemaker with combipolar atrial sensing system has stronger ability of anti myopotential interference and longer lifespan of the generator.