心室起搏管理功能降低病窦综合征患者高比例的右室起搏
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摘要
目的评估具有心室起搏管理(MVP)功能的双腔起搏器对高比例右室起搏的病窦综合征(SSS)患者的疗效。方法 35例SSS患者,房室传导正常或合并间歇性房室传导阻滞(AVB),至少植入了两年双腔起搏器(DDD/R),并计划更换,入组前1个月以上的心室起搏比例超过40%。均植入具有MVP功能的双腔起搏器,随机程控MVP启动(MVP on组,n=17)或者关闭(MVP off组,n=18)。术前、术后6个月行血浆脑钠肽(BNP)测定;心脏超声测定左室收缩末期内径(LVESD),左室舒张末期内径(LVEDD),左室射血分数(LVEF);并于术后6个月程控起搏器了解右室起搏比例、心房高频事件。结果术前两组血浆BNP及LVESD、LVEDD、LVEF比较无显著差异(P>0.05);术后两组有关心脏超声指标无明显变化(P>0.05)。MVP on组术后较术前血浆BNP有明显下降(P﹤0.05),与MVP off组比较,MVP on组术后右室起搏百分比、心房高频事件发生率均有显著下降(2.6%±0.6%vs 48.4%±10.5%,15.7%±2.3%vs 62.0%±7.8%;P﹤0.01)。结论具有MVP功能的DDD/R起搏器能降低高比例右室起搏的SSS的右室起搏比例及心房高频事件的发生率。
Objective To investigate the effect of managed ventricular pacing(MVP) function dual chamber pacemaker on sick sinus syndrome(SSS) patients with a high proportion of right ventricular pacing.Methods A total of 35 cases of SSS patients with normal atrioventricular conduction or intermittent atrioventricular block were implanted with dual chamber pacemaker(DDD/R)at least two years ago.They all wanted to change DDD/R into MVP function pacemaker instead.Before the operation,the proportion of ventricular pacing of DDD/R was over 40% more than a month.Program control of MVP was randomly on(MVP-on group,n=17) or off(MVP-off group,n=18).The brain natriuretic peptide(BNP) level in plasma of all patients were determined before the operation and 6 monthes after the operation.Left ventrieular end diastolic diameter(LVEDD),left ventrieular end systolic diameter(LVESD) and left ventricular ejection fraction(LVEF) were also determined.Six monthes later after the operation,program control was applied to obtain the proportion of right ventricular pacing and the events of atrial high-frequency.Results Before the operation,there was no statistical different between the MVP-on group and the MVP-off group in plasma levels of BNP,LVEDV,LVESV and LVEF(P>0.05).After the operation,the parameters of echocardiography between the MVP-on group and the MVP-off group didn′t have any statistical different either(P>0.05).In MVP-on group,the plasma BNP levels were significant decreased after the operation(P<0.05).Compared with the MVP-off group,in the MVP-on group,the proportion of right ventricular pacing and the events of atrial high-frequency were significant decreased(2.6%±0.6% vs 48.4%±10.5%,15.7%±2.3% vs 62.0%±7.8%;P﹤0.01).Conclusions DDD/R pacemaker with MVP function could decrease the proportion of right ventricular pacing and the occurrence of atrial high-frequency events in the SSS patients with high proportion of right ventricular pacing.
Objective To investigate the effect of managed ventricular pacing(MVP) function dual chamber pacemaker on sick sinus syndrome(SSS) patients with a high proportion of right ventricular pacing.Methods A total of 35 cases of SSS patients with normal atrioventricular conduction or intermittent atrioventricular block were implanted with dual chamber pacemaker(DDD/R)at least two years ago.They all wanted to change DDD/R into MVP function pacemaker instead.Before the operation,the proportion of ventricular pacing of DDD/R was over 40% more than a month.Program control of MVP was randomly on(MVP-on group,n=17) or off(MVP-off group,n=18).The brain natriuretic peptide(BNP) level in plasma of all patients were determined before the operation and 6 monthes after the operation.Left ventrieular end diastolic diameter(LVEDD),left ventrieular end systolic diameter(LVESD) and left ventricular ejection fraction(LVEF) were also determined.Six monthes later after the operation,program control was applied to obtain the proportion of right ventricular pacing and the events of atrial high-frequency.Results Before the operation,there was no statistical different between the MVP-on group and the MVP-off group in plasma levels of BNP,LVEDV,LVESV and LVEF(P>0.05).After the operation,the parameters of echocardiography between the MVP-on group and the MVP-off group didn′t have any statistical different either(P>0.05).In MVP-on group,the plasma BNP levels were significant decreased after the operation(P<0.05).Compared with the MVP-off group,in the MVP-on group,the proportion of right ventricular pacing and the events of atrial high-frequency were significant decreased(2.6%±0.6% vs 48.4%±10.5%,15.7%±2.3% vs 62.0%±7.8%;P﹤0.01).Conclusions DDD/R pacemaker with MVP function could decrease the proportion of right ventricular pacing and the occurrence of atrial high-frequency events in the SSS patients with high proportion of right ventricular pacing.
引文
1张常莹,王如兴.心室起搏管理[J].中国心脏起搏与心电生理杂志,2010,24(4):292
2 Toff WD,Camm AJ,Skehan JD.United Kingdom Pacing:Cardio-vascular Events Trial Investigati on.Single-chamber versus dual-chamber pacing for high-grade arioventricular block[J].N Engl JMed,2005,353(2):145
3 Sweeney MO,Bank AJ,Nsah E,et al.Minimizing ventricular pacingto reduce atrial fibrillation in sinus-node disease for the Search AVextension and managed ventricular pacing for promoting atrioventric-ular conduction(SAVE PACe)trial[J].N Engl J Med,2007,27(357):1 000
4 Shukla HH,Flaker GC,Hellkamp AS,et al.Clinical and quality oflife comparison of accelerometer,piezoelectric crystal,and blendedsensors in DDDR-paced patients with sinus node dysfunction in themode selection trial(MOST)[J].PACE,2005,28(8):762
5郭继鸿.最小化心室起搏优势的新证据[J].中国心脏起搏与心电生理杂志,2008,22(4):283
2 Toff WD,Camm AJ,Skehan JD.United Kingdom Pacing:Cardio-vascular Events Trial Investigati on.Single-chamber versus dual-chamber pacing for high-grade arioventricular block[J].N Engl JMed,2005,353(2):145
3 Sweeney MO,Bank AJ,Nsah E,et al.Minimizing ventricular pacingto reduce atrial fibrillation in sinus-node disease for the Search AVextension and managed ventricular pacing for promoting atrioventric-ular conduction(SAVE PACe)trial[J].N Engl J Med,2007,27(357):1 000
4 Shukla HH,Flaker GC,Hellkamp AS,et al.Clinical and quality oflife comparison of accelerometer,piezoelectric crystal,and blendedsensors in DDDR-paced patients with sinus node dysfunction in themode selection trial(MOST)[J].PACE,2005,28(8):762
5郭继鸿.最小化心室起搏优势的新证据[J].中国心脏起搏与心电生理杂志,2008,22(4):283