闭环刺激双腔频率适应性起搏器的临床应用

Clinical evaluation of dual chamber pacemaker with closed loop stimulation rate adaptive function

目的 介绍感知体动和精神活动的闭环刺激双腔频率适应性起搏器的初步应用经验。方法 植入第３ｄ开启闭环刺激频率适应功能，患者进行坐卧位、散步、快走、上下楼、思考等活动，第７ｄ动态心电图检查和起搏器程控。３个月后随访，重复上述活动和检查，对比分析结果。结果１８例患者植入闭环刺激双腔频率适应性起搏器（Ｂｉｏｔｒｏｎｉｋ公司的 Ｉｎｏｓ～２ＣＬＳ ＤＤＤＲ），心室起搏阈值０．３～０．７（０．４±０．３）Ｖ，Ｒ波振幅 ９．５～２１．８ （ｌ４．６ ± ７．５）ｍＶ，阻抗 ５２０～８７０（６１０±７８）Ω；心房起搏阈值０．３～０８（０．５±０．３）Ｖ，Ａ波振幅７．２～１６．４（１１．６±５．７）ｍＶ，阻抗５１０～８７２（６９７±９２）ｍＶ。随访５０～４８６（２３６±１０７）ｄ，均为频率适应性双腔起搏，体力和脑力活动时起搏频率能按需增加。与植入时相比，频率适应功能增强且更加个体化。结论 Ｉｎｏｓ～２ＣＬＳ除适应体动变化外，还能适应精神负荷变化，自动完成初始参数和昼夜频率调整，程控简单，随访方便。

Objective Report the preliminary experience of a new DDDR pacemaker with closed loop stimu- lation rate adaptive function. Methods In the 3rd day after pacemaker implantation, the closed loop function was started. Patients were asked to complete position change, walk, up and down stairs, think or calculate. Holter moni- toring and pacemaker programming were conducted at the 7th day. Above tests were repeated in 3 months and the re- sults were compared. Results Eighteen patients [male 11, female 7, 58-76 (64 ± 17)years old, arrhythmic his- tory 2 - 11(7 ± 3) years] were implanted a Inos2 CLS DDDR pacemaker without complication. The ventricular pacing threshold, R amplitude and lead resistance were 0.3-0.7(0.4±0.3)V, 9.5-21.8(14.6±7.5)mV and 520- 870(610±78)Ω, respectively. The atrial pacing threshold, A wave amplitude and lead resistance were 0.3-0.8 (0. 5±0.3)V, 7.2-16.4(11.6±5.7)mV and 510-872(697±92)Ω, respectively. During follow-up of 50- 486 (236 ± 107) days, the pacemaker worked well. Conclusion Inos2CLS DDDR pacemaker has the advantages of: (1) responsive to both physical and mental activity; (2) having the automatic and dynamic parameter recognition and regulation function, as well as circadian variation and mode switch function; (3) simpler programming and fol- low-up.