Kurz D J, Naegeli B, Kunz M, Genoni M, Niederhäuser U, Bertel O
Department of Internal Medicine, Triemli Hospital, Zurich, Switzerland.
Pacing Clin Electrophysiol. 1999 May;22(5):721-6. doi: 10.1111/j.1540-8159.1999.tb00535.x.
About 30% of patients develop AF after open heart surgery. Biatrial synchronous pacing (BSP) has been shown to promote sinus rhythm in patients with paroxysmal AF refractory to drug therapy. We conducted a prospective, randomized study to test the effect of BSP via epicardial electrodes on the incidence of AF after heart surgery, as compared to conventional therapy. To apply BSP, we attached two epicardial electrodes to the right and one to the left atrium. Immediately following surgery, BSP was initiated in the AAI-Mode at a rate of 10 beats/min above the underlying rhythm (maximum 110 beats/min) and continued for 3 days, during which the rhythm was continually monitored. After 21 (age 63 +/- 9 years) of the planned 200 patients, the study was prematurely aborted because of the proarrhythmic effect of BSP: 6 of the 12 patients treated with BSP developed sensing failure (P amplitude < 1 mV), which provoked AF in 5 of these 6 patients. BSP was discontinued due to diaphragmal stimulation in two patients and due to ventricular stimulation by a dislocated left atrial electrode in one patient. Two patients in the control group (n = 9) developed AF. Using the available standard technology, BSP via epicardial electrodes is not suitable to suppress AF after heart surgery, primarily due to postoperative deterioration of atrial sensing and its profibrillatory effect. In patients requiring atrial pacing after heart surgery, sensing thresholds must be closely monitored to prevent induction of AF.
约30%的患者在心脏直视手术后会发生房颤。双心房同步起搏（BSP）已被证明可促进对阵发性房颤药物治疗无效的患者恢复窦性心律。我们进行了一项前瞻性随机研究，以测试与传统治疗相比，经心外膜电极进行BSP对心脏手术后房颤发生率的影响。为了应用BSP，我们在右心房连接了两个心外膜电极，在左心房连接了一个。手术后立即以AAI模式启动BSP，频率比基础心律高10次/分钟（最大110次/分钟），并持续3天，在此期间持续监测心律。在计划纳入的200例患者中的21例（年龄63±9岁）后，由于BSP的促心律失常作用，该研究提前终止：12例接受BSP治疗的患者中有6例出现感知失败（P波振幅<1mV），这6例患者中有5例诱发了房颤。由于膈肌刺激，两名患者停止了BSP，一名患者因左心房电极移位导致心室刺激而停止BSP。对照组（n=9）中有两名患者发生了房颤。使用现有的标准技术，经心外膜电极进行BSP不适合抑制心脏手术后的房颤，主要是由于术后心房感知功能恶化及其促纤颤作用。在心脏手术后需要心房起搏的患者中，必须密切监测感知阈值，以防止诱发房颤。
