心脏抑制型血管迷走性晕厥患者个体化起搏优化治疗

Individualized optimizing strategy in cardioinhibitory vasovagal syncope patients with pacing therapy

目的观察基于直立倾斜试验的个体化频率骤降反应(RDR)参数设置在血管迷走性晕厥(VVS)患者起搏治疗中的作用。方法连续入选2016年1月至2023年4月期间经直立倾斜试验证实为心脏抑制型VVS患者,所有患者均植入具有RDR功能的双腔起搏器。收集其临床基线资料、基线起搏和RDR参数设置。对患者进行定期随访,个体化调整起搏参数和RDR参数,观察调整后患者随访结果。结果7例患者符合入选标准,中位年龄59岁,男性3例,所有患者均未合并病窦综合征。中位随访时间10(2~51)个月,早期5例患者中4例月均RDR事件大于150次,其中1例因RDR运作次数多出现心悸症状,2例仍有黑矇症状发作。参考直立倾斜试验阳性症状时患者心率下降和恢复的特征个体化调整参数可以减少RDR事件不适当发作;仍有晕厥前兆患者调整RDR骤降频率高于低限起搏频率后患者症状缓解。结论对于接受具有RDR功能起搏治疗的心脏抑制型VVS患者而言,参考直立倾斜试验阳性症状时心率下降和恢复特征,以及随访过程中的症状发作情况个体化调整起搏参数,既有利于减少RDR事件的不适当发作,又可有效避免晕厥发作。

Objective To investigate the effect of individualized rate drop response(RDR)parameter setting based on tilt table test in the patients with vasovagal syncope(VVS)treated with pacemaker.Methods The patients with cardioinhibitory VVS diagnosed by tilt table test were enrolled from January 2016 to April 2023.All patients were implanted dual-chamber pacemakers with RDR function.Baseline clinical characteristics,the details of tilt table test,pacing and RDR parameters were collected.The patients were followed up regularly,pacing and RDR parameters were individually adjusted,and clinical outcomes after adjustment were recorded.Results A total of 7 patients with VVS were enrolled.Median age was 59 years old,3 cases of them were males.No patient combined with sick sinus syndrome.The median follow-up time was 10(2-51)months.Among the 5 cases in the early stage,more than 150 episodes per month of RDR events in 4 cases.There was palpitation due to overload ventricular pacing of RDR events in 1 case and presyncope symptoms in 2 cases.Individualized pacing and RDR parameters adjustment according to the characteristics of heart rate decline and recovery in tilt table test could reduce inappropriate RDR events.Programming RDR detection drop rate higher than lower rate limit could relieve presyncope symptoms in some patients.Conclusions Individualized programming strategy according to the characteristics in tilt table test and symptoms during follow-up could reduce inappropriate RDR events and syncope episode in patients with cardioinhibitory VVS treated with dual chamber pacemaker.