应用生理性起搏器治疗35例缓慢型心律失常的临床体会

The Clinical Effect of Physiological Pacing in 35 Patients with Bradyarrhythmia

目的 探讨生理性起搏器在缓慢型心律失常中的临床疗效与安全性。方法 共 35例患者 ,起搏器包括DDD9例 ,双房三腔起搏器 1例 ,VDD3例 ,VVIR2 2例。结果 35例患者均手术成功 ,术中测得心室起搏阈值为 0 .4 2± 0 .13V/ 0 .5 ms,阻抗 5 6 0± 130 ohm,R波振幅 9.8± 2 .2 m V;右心房起搏阈值为 0 .89± 0 .2 7V/ 0 .5 ms,阻抗 6 70±180 ohm,P波振幅 2 .8± 1.2 m V,P波感知灵敏度 0 .4 8± 0 .3m V。 A- V间期程控在 14 0～ 16 0 m s之间 ,频率适应参数程控为反应时间和恢复时间取中档值 ,增益取低档值 ,下限频率程控为 6 0～ 70 bpm,上限频率程控于 110～ 130 bpm之间 ,感知阈值取中档 ,频率适应档次取 4～ 5。随访 4～ 5 0个月 ,所有患者的生活质量明显提高 ,无起搏器并发症发生。结论 生理性起搏可产生较好的血液动力学效应 ,改善心功能 ,提高运动耐量 。

Objective\ To evaluate the clinical effect of physiological pacing in bradyarrhythmias.Methods\ 35 patients were treated with physiological pacemaker,including DDD 9,VDD 3,VVIR 22 and 1 three chamber biatrial pacemaker.The electrode leads were positioned visubclavian vein.Results\ The pacing threshold of right ventricular leads were 0 42±0 13V,the resistence were 560±130 ohm and the amplitude of R wave were 9 8±2 2mV The pacing threshold of right atrial leads were 0 89±0 27V,the resistence were 670±180 ohm,the amplitude of P wave were 2 8±1 2mV.The AV intervals of dual chamber pacemakers were programmed between 140～160ms.The rate adaptive parameters were set at middle value.There were no complications.Conclusion\ Physiological Pacing may improve the hemodynamic effects and can be applied safely to patients with bradyarrhythmias. \