房室传导阻滞患者起搏比例影响因素分析

Analysis of factors influencing the percentage of ventricular pacing in patients with atrioventricular block

目的分析可能影响房室传导阻滞(AVB)植入永久起搏器患者起搏比例(%VP)的因素,指导起搏器的优化程控。方法从2006年1月至2014年8月,因AVB于北京协和医院心内科植入永久起搏器患者纳入研究,规律随访。收集患者的临床资料和起搏器程控随访记录,将%VP>70%定义为起搏依赖。入选患者按起搏比例分为依赖组和非依赖组。结果共入选228例,男性125例,年龄(68.2±14.5)岁。中位随访时间24个月,起搏依赖组共178例(79.5%)。与非依赖组比较,依赖组年龄≥65岁、三度AVB、持续性AVB、心功能不全、高血压、双腔起搏患者的比例均更高(P均<0.05)。多因素分析发现,年龄≥65岁、三度AVB、持续性AVB、植入双腔起搏器、基线心功能正常是影响起搏比例的独立危险因素(P均<0.05,OR 2.536,1.624,3.543,1.839,2.842)。结论年龄≥65岁、三度AVB、持续性AVB、植入双腔起搏器、基线心功能正常与起搏依赖相关。

Objective To analyze the risk factors which may affect cumulative ventricular pacing proportion(%VP)in atrioventricular block(AVB)patients,with the aim of providing guidance for electrophysiologists when programming pacemaker.Methods Patients with AVB indicated for pacemaker implantation were enrolled in Peking Union Medical College Hospital between January 2006 and September 2014.Clinical characteristics and programming data were analyzed.Pacing dependency was defined as VP%>70%.Results There were 125 males of 228 patients.The mean age was(68.2±14.5)years.The median time of follow-up was 24 months.One hundred and seventy-eight patients(79.5%)were pacing dependent.Compared with pacing independent patients,more patients with older age,third degree AVB,persistent AVB,normal heart function,hypertension and dual chamber pacing were pacing dependent(P<0.05).Old age,third degree AVB,persistent AVB,dual chamber pacing and normal heart function were independent risk factors which affect%VP(P<0.05,OR 2.536,1.624,3.543,1.839,2.842).Conclusion Older patients with dual chamber pacing,persistent and third degree AVB as well as normal heart function are more likely to be pacing dependent.