心房起搏位点与起搏器术后心房颤动的关系

The Relationship Between Atrial Pacing Sites and Atrial Fibrillation after Pacemaker Implantation

目前有越来越多的患者行心脏双腔起搏器植入,不论既往有无心房颤动发作,术后其发生率都较高。由于心房导线植入后,改变了双房间延迟区传导时间、心肌不应期离散度、正常心脏激动顺序,从而导致心房颤动的发生。已有许多动物实验及临床试验对心房不同位点起搏进行了研究,发现房间隔及上房间束起搏可以缩短P波及PR间期,甚至逆转心房重构,但对心房颤动发作及心房颤动负荷得出不同结论。经分析,研究结果的差异可能由于样本量不足、随访时间较短以及起搏部位不准确导致无效起搏等引起。

At present, dual-cliamber pacemakers are frequently implanted in patients. With or without atrial fibrillation history,its incidence is high after operation. It can change delayed conduction time,myocardial refractory period dispersion and normal cardiac exciting sequence after implantation,leading to the occurrence of atrial fibrillation. Many animal and clinical experiments of different atrial pacing sites found that interatrial septum and Bachmann bundle pacing had shortened P-wave and PR interval,and reversed atrial remodeling, but these experiments had different conclusions of atrial fibrillation load. The different results maybe caused by insufficient sample size,shorter follow-up time, and difficulty in confirming the location and ineffective pacing.