长期AAI起搏治疗病态窦房结综合征伴阵发性心房颤动

Long-term Follow-up of AAI Pacing in Patients with Sick Sinus Syndrome and Paroxysmal Atrial Fibrillation

选择 5例病态窦房结综合征 (SSS)伴心房颤动(Af)的患者 ,发生Af的时间平均为 8.8± 7 9个月 ,房颤持续时间 1小时～ 5个月。心脏电生理检查均有严重的窦房结功能障碍 ,房室传导功能未见明显异常。 5例患者均采用锁骨下静脉穿刺法安装了AAI型心脏起搏器 ,其中 1例术前电复律成功后置入起搏装置。 5例患者均一次置入成功 ,心脏起搏器状态良好。随访 5～ 7年 (平均 5 .8± 1.7年 ) ,4例未发生Af,1例起搏器安装半年后心房颤动再发 ,奎尼丁转复后服用胺碘酮未复发 ,1例房早较多需要长期应用钙拮抗剂。因此 ,对某些SSS患者 ,如果Af发生系由窦性心动过缓触发 ,房室传导功能正常 ,我们初步认为可作为安装AAI型人工心脏起搏器的适应证 ,它既可以缓解SSS引起的症状 ,又可以防止Af的发生。

Objective To Observe long term effect of AAI pacing on paroxysmal atrial fibrillation in patients with sick sinus syndrome. Methods Five patients with bradycardia tachycardia syndrome (paroxysmal atrial fibrillation for 8.8±7.9 months) and normal atrial ventricular conduction function were selected. All of patients were treated with AAI pacing and followed up to observe occurrence of atrial fibrillation. Results Pacing function of AAI pacemaker were normal for 5.8±1.7 years of follow up. Atrial fibrillation were not detected in 4 patients. Atrial fibrillation in 1 patient occurred 6 months after pacemaker implantation and defibrillation were performed with quinidine and sinus rhythm were maintained with cordarone. Conclusion If paroxysmal atrial fibrillation were induced by bradycardia, the best choice of therapy may be AAI pacing in patients with sick sinus syndrome and normal atrial ventricular conduction function in order to release symptom and prevent atrial fibrillation.