Sassara M, Achilli A, Guerra R, Capezzuto A, De Luca F, Serraino L, Savelli S, Achilli P, Audoglio R, Scabbia E V
Divisione di Cardiologia, Ospedale Belcolle, Viterbo.
Ital Heart J Suppl. 2000 Jun;1(6):777-82.
During the last decade single lead VDD pacing has been progressively affirmed as an electrotherapy of choice in patients with advanced atrioventricular block without alterations of the sinus function. It combines the benefits of P-synchronous ventricular pacing with an easy implant procedure when compared to the conventional DDD approach. The aim of this study was to evaluate the validity of such an approach in a large population of patients, all implanted in a single center.
From 1987 up to now, 317 patients, all affected by advanced atrioventricular block and without sinus node dysfunction, were implanted in our center with a single lead VDD pacemaker. During follow-up the persistence of a proper atrioventricular synchronization was assessed and evaluated.
The mean follow-up was 3.9 +/- 2.7 years/patient (range 6-138 months). The 94.6% of implanted systems maintained the normal VDD pacing function. Permanent reprogramming in VVI mode was necessary in 17 patients (5.36%); in 12 (3.78%) because of chronic atrial fibrillation and in 5 (1.63%) for loss of atrial sensing. The percentage of atrial synchronization was optimal (> 98%) and acceptable (> 95%) in 81% and 19% of patients, respectively. Episodes of paroxysmal atrial fibrillation occurred in 3 patients. Neither inhibition by myopotentials nor occurrence of sinus node disease was observed during follow-up. These results are in accordance with those reported by previous studies, performed on a smaller population or on a multicenter basis, and are comparable with the results reported for conventional DDD pacemaker.
Our results confirm the high reliability of the single lead VDD pacing system concerning the long-term persistence of a proper atrioventricular synchronization. Data showed above enforce our opinion that this pacing approach should be considered the treatment of choice in patients with advanced atrioventricular block and preserved sinus node function.
在过去十年中，单导联VDD起搏已逐渐被确认为治疗晚期房室传导阻滞且窦房功能无异常患者的首选电疗法。与传统的DDD方法相比，它兼具P波同步心室起搏的优点且植入过程简便。本研究的目的是评估在同一中心植入该起搏器的大量患者中这种方法的有效性。
从1987年至今，我们中心为317例晚期房室传导阻滞且无窦房结功能障碍的患者植入了单导联VDD起搏器。在随访期间，评估并评价了房室同步性的维持情况。
患者的平均随访时间为3.9±2.7年（范围6 - 138个月）。94.6%的植入系统维持了正常的VDD起搏功能。17例患者（5.36%）需要永久性程控为VVI模式；其中12例（3.78%）是因为慢性房颤，5例（1.63%）是因为心房感知丧失。分别有81%和19%的患者心房同步率最佳（>98%）和可接受（>95%）。3例患者发生阵发性房颤。随访期间未观察到肌电位抑制或窦房结疾病的发生。这些结果与之前在较小样本或多中心研究中报道的结果一致，并且与传统DDD起搏器报道的结果相当。
我们的结果证实了单导联VDD起搏系统在长期维持适当房室同步方面的高度可靠性。上述数据进一步支持了我们的观点，即这种起搏方法应被视为晚期房室传导阻滞且窦房结功能保留患者的首选治疗方法。
