特殊心脏起搏模式预防性治疗阵发性心房颤动

The prophylactic effect of special pacing therapy on paroxysmal atrial fibrillation

目的 研究房早抑制、房早后反应、频率骤降抑制和起搏调控等四种特殊模式抗房颤起搏器预防性治疗心房颤动的疗效。方法 10例植入VitatronSelection90 0E起搏器的阵发性房颤患者 ,随访 16周 ,分为阶段Ⅰ /监测阶段、阶段Ⅱ /快频率起搏治疗阶段、阶段Ⅲ /联合模式抗房颤起搏治疗阶段和阶段Ⅳ /优化模式抗房颤起搏治疗阶段。结果 阶段Ⅰ房颤负荷为 (8 9± 5 1) % ,窦律维持时间为 (0 2 7± 0 31)d ,以短串房颤居多 ;阶段Ⅱ相近 ;阶段Ⅲ 8例患者中 6例有效 ,房颤负荷呈下降趋势 ;窦律维持时间呈延长趋势。阶段Ⅳ 7例治疗有效 ,房颤负荷显著下降至 (4 7± 3 0 ) % ,短串房颤例数显著减少。结论 抗房颤起搏治疗能预防性减少房颤发生 。

Objective To investigate the effect of special modes of pacing therapies on paroxysmal atrial fibrillation(AF).Methods Ten patients with paroxysmal atrial fibrillation and sick sinus syndrome had Vitatron Selection 900E dual chamber cardiac pacemakers implanted.16-week follow up was divided into 4 stages:stage one was monitoring stage,stage two pacing therapy with high fixed rate,stage three pacing therapy with combined 4 special anti-AF modes(pacing conditioning,premature atrial contration(PAC)suppression,post-PAC response and post-exercise response),stage four optimized pacing therapy with selective anti-AF therapy modes.Results 8 patients completed the whole follow-up.In stage one,AF burden was (8.9±5.1)%,sinus rhythm sustained time(SRST)was (0.27±0.31)days.AF episodes less than 60 minutes accounted for (93.8±6.1)%.Similar results were observed in stage two.In stage three,pacing therapy was effective in 6 cases,total AF burden trended to decreased and SRST trended to be prolonged.Efficient therapy was observed in 7 cases in stage four.AF burden dropped to (4.7±3.0)% statistically significantly.The frequency of AF and PAC prevalence tended to decrease in stage three and four,while the ratio of AF shorter than 60 minutes decreased significantly. Conclusion Pacing therapy with special pacing modes can preventively decrease AF,possibly especially for the short episodes AF.