具有自动夺获功能起搏器刺激除极波振幅的影响因素及远期随访

Evaluation of the Evoked Resporse Amplitude With Autocapture.

观察刺激除极波 (evokeresponse,ER)振幅及极化电位在远期随访中的稳定性及不同体位对其的影响 ,分析ER振幅与起搏器一般工作参数的关系。对 1996年 12月～ 1998年 12月之间收治的 2 4例埋置了RegencySC +2 40 2L永久起搏器的患者进行 2 .43± 0 .6 2 (2～ 3.5 )年的随访观察。结果 :ER振幅及极化电位在随访期间是稳定的 ,平卧位时ER振幅最低为 8.5 0± 3.0 2mV ,立位时最高达 9.32± 2 .95mV ,两者有统计学差异 ,P <0 .0 5。其他体位之间无差异。极化电位与体位变化无关。 2 / 2 4例分别因极化电位升高、ER振幅降低同时伴极化电位升高 ,而至自动夺获功能不能工作。ER振幅与起搏器一般工作参数无相关性。结论 :ER及极化电位在随访期间是稳定的 ,体位对ER振幅有一定影响 ,个别病例出现ER及 /或极化电位的变化 。

The aims of the study were to evaluate the stability of the evoked response(ER) amplitude and polarization and to assess whether these parameters were influenced by body positions or other electrical parameters.Pacermakers with autocapture function (Regency SC+2402L) were implanted in 24 patients.Patients were followed up for 2.43±0.62 years.Results:Durig follow up,the ER remained stable,except for two patients who developed an inadequate ER to allow the normal function of the autocapture system.The ER signal while in the supine position was 8.50±3.02 mV and increased significantly to 9.32±2.95 mV in the upright position( P < 0.05 ).The ER amplitude was the lowest in supine position,but not differently distributed( P >0.05) in supine position compared to right lateral position or left lateral position.Polarization remained unchanged in all kinds of position.None of the pacing threshold,the pacing impedance or the spontaneous R wave amplitude correlated with the ER amplitude.It was not recommended to program autocapture function on in two patients.The reasons were a decrease of the ER in one and increase of the polarization in the other.Conclusion:During follow up,the ER amplitude and polarization remained stable.The ER shows some variations in various body position.Autocapture activation should be carefully assessed for the possible unfavorable ER/polarization ratio that could make autocapture activation unsuitable.