起搏器术后新发房性心律失常的影响因素分析

Analysis of the Influencing Factors of Atrial Arrhythmia after Cardiac Permanent Pacemaker Implantation

目的:探讨起搏器术后新发房性心律失常的发生情况及其相关影响因素。方法:选择2006年1月至2007年12月于沈阳军区总医院首次植入永久起搏器的107例患者,男性50例,平均年龄65.0±11.9岁,术前通过追问病史及相关检查均排除房性心律失常(房颤、房扑、房速),术后平均随访3.9年,观察新发房性心律失常情况。按术后是否出现房性心律失常,将患者分为新发房性心律失常组和无房性心律失常组,比较两组患者术前和术后心脏超声结果的变化、心室起搏比例、起搏部位及起搏模式,并通过logistic回归分析起搏器术后发生房性心律失常的影响因素。结果:新发房性心律失常组26例(24.3%),其中房颤17例(15.9%),房扑2例(1.9%),房速7例(6.5%);无房性心律失常组81例。与无房性心律失常组比较,新发房性心律失常组左房内径明显增加(P=0.040)、二尖瓣返流程度较重(P=0.032)及左室射血分数明显下降(P=0.001),心室起搏百分比(VP%)显著升高(P=0.017)。心尖部起搏患者房性心律失常的发生率明显高于间隔部起搏(33.3%vs 16.9%,P<0.05),双腔起搏组患者房性心律失常发生率明显低于单腔起搏器组(18.7%vs 37.5%,P<0.05)。Logistic回归分析显示术后新发房性心律失常的发生与高比例的心室起搏(P=0.006)、VVI(R)起搏模式(P=0.014)及右心室起搏电极导线植于心尖部(P=0.024)显著相关。结论:起搏模式、心室起搏百分比、起搏部位是起搏器术后发生房性心律失常的影响因素。

Objective： To evaluate the incidence and related influencing factors of atrial arrhythmia in patients after cardiac permanent pacemaker implantation. Methods： 107 cases underwent cardiac pacemaker therapy for the first time in General Hospital of Shenyang Military Command from January 2006 to December 2007 were enrolled in this study（male： 50, mean age： 65.0 ±11.9 years）.These patients who had atrial arrhythmia（atrial fibrillation, atrial flutter, atrial tachycardia） before implantation were excluded by learning the history and examination. According to whether the patients had postoperative atrial arrhythmias, the patients with postoperative atrial arrhythmia were defined as the new-onset atrial arrhythmi group, the others were considered as the non-atrial arrhythmia group. The changes of cardiac ultrasound results, ratio of ventricular pacing, pacing site and pacing mode were compared between the two groups before and after surgery, and logistic regression analysis was used to analyze the factors affecting postoperative atrial arrhythmia pacemaker through. Results： After 3.9 years＇ follow-up, there were 26 patients（24.3 %） with at least one atrial arrhythmia, including 17 cases with atrial fibrillation（15.9 %）; 2 cases with atrial flutter（1.9 %）; 7 cases with atrial tachycardia（6.5 %）;81 patients with none atrial arrhythmia. In the new-onset atrial arrhythmi group, there were significantly changes in the left atrial diameter increased significantly（P=0.040）, severe mitral regurgitation（P=0.032） and left ventricular ejection fraction decreased significantly（P=0.001）, ventricular pacing percentage（VP%） was significantly higher（P=0.017）, Apical pacing incidence of atrial arrhythmias in patients was significantly higher than the interval pacing（33.3% vs 16.9%, P〈0.05）, the incidence of atrial arrhythmias in patients with dual-chamber pacing group was significantly lower than that of the single-chamber pacing control group（18.7% vs 37.5%, P〈0.05）. But in the non-atrial arrhythmia patients, there was no changes. Logistic regression analysis showed that the high percentage of ventricular pacing（VP%）（P=0.006）, right ventricular apical（RVA）pacing（P=0.024） and VVI（VVIR） mode（P=0.014） before the occurrence of atrial arrhythmia were the independent predictors of new-onset atrial arrhythmia after pacemaker implantation. Conclusion： Pacing mode, the percentage of ventricular pacing, pacing sites were the independent predictors of new-onset atrial arrhythmia after pacemaker implantation.