Benditt D G, Sutton R, Gammage M, Markowitz T, Gorski J, Nygaard G, Fetter J
Department of Medicine, University of Minnesota Medical School, Minneapolis, USA.
J Interv Card Electrophysiol. 1999 Mar;3(1):27-33. doi: 10.1023/a:1009815304770.
Recent reports suggest that cardiac pacing incorporating a rate-drop response algorithm is associated with a reduction in the frequency of syncopal episodes in patients with apparent cardioinhibitory vasovagal syncope. The detection portion of the algorithm employs a programmable heart rate change-time duration "window" to both identify abrupt cardiac slowing suggestive of an imminent vasovagal event and trigger "high rate" pacing. The purpose of this study was to develop recommendations for programming the rate-drop response algorithm. Pacemaker programming, symptom status, and drug therapy were assessed retrospectively in 24 patients with recurrent vasovagal syncope of sufficient severity to warrant consideration of pacemaker treatment. In the 53 +/- 19 months prior to pacing, patients had experienced an approximate syncope burden of 1.2 events/month. During follow-up of 192 +/- 160 days, syncope recurred in 4 patients (approximate syncope burden, 0.3 events/month, p < 0.05 vs. pre-pacing), and pre-syncope in 5 patients. In these patients, rate-drop response parameters were initially set based on electrocardiographic and/or tilt-table recordings, and were re-programmed at least once in 14 (58%) individuals. A 20 beat/min window height (top rate minus bottom rate), a window width of 10 beats (61% of patients), and 2 or 3 confirmation beats (79% of patients) appeared to be appropriate in most patients. Treatment intervention rate was set to > 100 beats/min in 89% of patients, with a duration of 1 to 2 min in 79%. In conclusion, a narrow range of rate-drop response parameter settings appeared to be effective for most individuals in this group of highly symptomatic patients.
最近的报告表明，采用心率下降反应算法的心脏起搏与明显心脏抑制型血管迷走性晕厥患者晕厥发作频率的降低有关。该算法的检测部分采用一个可编程的心率变化-持续时间“窗口”，以识别提示即将发生血管迷走事件的心脏突然减慢，并触发“高速率”起搏。本研究的目的是制定心率下降反应算法的编程建议。对24例复发性血管迷走性晕厥严重程度足以考虑起搏器治疗的患者进行了回顾性评估，包括起搏器编程、症状状态和药物治疗。在起搏前53±19个月期间，患者每月晕厥负担约为1.2次。在192±160天的随访期间，4例患者再次发生晕厥（晕厥负担约为每月0.3次，与起搏前相比p<0.05），5例患者发生前驱晕厥。在这些患者中，心率下降反应参数最初根据心电图和/或倾斜试验记录进行设置，14例（58%）患者至少重新编程一次。大多数患者似乎适合采用20次/分钟的窗口高度（最高心率减去最低心率）、10次心跳的窗口宽度（61%的患者）以及2次或3次确认心跳（79%的患者）。89%的患者治疗干预心率设置为>100次/分钟，79%的患者持续时间为1至2分钟。总之，在这组症状严重的患者中，大多数个体采用较窄范围的心率下降反应参数设置似乎是有效的。
