闭环刺激起搏在血管迷走性晕厥治疗中的应用现状分析

Analysis Application of Closed-loop Stimulated Pacing in Treatment of Vasovagal Syncope

起搏器治疗血管迷走性晕厥的获益目前仍存在争议,通常建议用于难治性迷走性晕厥伴发心脏停搏的患者。闭环刺激起搏通过感知程控发现心脏收缩性的变化从而增加心率对血压下降作出应答。目前多项随机观察研究结果表明闭环刺激起搏对于减少心脏抑制型血管迷走性晕厥患者的晕厥发作优于传统起搏治疗,少数研究结果表明闭环刺激起搏对于减少血管抑制型和混合型迷走性晕厥患者的晕厥发作治疗有限。

The benefit of pacemaker in treatment of vasovagal syncope remains controversial and is currently recommended for patients with recurrent syncope and asystole. Closed-loop stimulation uses a sensing algorithm that can detect the variation in cardiac contractility and respond to drop in blood pressure by increasing the heart rate. Recently,multiple observational and randomized studies showed its superiority to conventional pacing in reducing the burden of syncopal attacks in patients with cardioinhibitory vasovagal syncope. A few studies suggested that closed-loop stimulation pacing is limited in patients with vasodepressor or mixed vasovagal syncope.