低位房间隔起搏对病态窦房结综合征合并房间阻滞患者新发房颤的影响

Influence of low atrial septal pacing on newly-onset atrial fibrillation in patients with sick sinus syndrome com-plicating inter-atrial block

目的探讨低位房间隔起搏(low atrial septal pacing,LASP)对病态窦房结综合征(简称病窦综合征)合并房间阻滞患者术后新发房颤的影响。方法选择住院的病窦综合征合并房间阻滞患者58例,根据心房电极植入部位分为LASP组(23例)和右心耳起搏(right atrial appendage pacing,RAAP)组(35例)。观察两组患者术前术后P波时限及P波离散度变化,术中及术后1、3、6、12个月心房电极参数变化,起搏相关并发症和新发房颤的发生情况。结果①两组患者的心房电极参数和起搏相关并发症发生率间的差异无统计学意义(P均>0.05);②LASP组患者起搏后,P波时限较RAAP组明显缩短[(117.7±7.0)ms vs.(135.1±8.9)ms,P<0.05],P波离散度亦比RAAP组明显降低[(23.9±4.5)ms vs.(31.5±5.5)ms,P<0.05];③LASP组术后房颤发生率明显低于RAAP组(0 vs.20.0%,P<0.05)。结论LASP可降低病窦综合征合并房间阻滞患者术后房颤发生率。

Objective To discuss the influence of low atrial septal pacing(LASP)on newly-onset atrial fibrillation in patients with sick sinus syndrome(SSS)complicating inter-atrial block.Methods Fifty-eight inpatients with SSS complicating inter-atrial block were selected,and divided into LASP group(n=23)and right atrial appendage pacing(RAAP)group(n=35)according to the implantation sites of atrial leads.The changes of P wave duration and P wave dispersion before and after the operation,and changes of atrial electrode parameters during the operation,one month and 3,6 and 12 months after the operation,and the occurrence of pacing related complications and newly-onset atrial fibrillation were observed in the two groups.Results(ⅰ)There is no significant difference in atrial electrode parameters and the incidence of pacing related complications between LASP group and RAAP group(P>0.05).(ⅱ)In the LASP group,the duration of P wave is significantly shorter than that in the RAAP group[(117.7±7.0)ms vs.(135.1±8.9)ms,P<0.05]after pacing while P wave dispersion is also sig-nificantly lower than that in the RAAP group[(23.9±4.5)ms vs.(31.5±5.5)ms,P<0.05]after pacing.(ⅲ)The incidence of postoperative atrial fibrillation in the LASP group is significantly lower than that in the RAAP group(0 vs.20.0%,P<0.05).Conclusion LASP could reduce the incidence of postoperative atrial fibrillation in patients with SSS complicating inter-atrial block.