Marshall H J, Kay G N, Hess M, Plumb V J, Bubien R S, Hummel J, Dawson D, Markewitz T, Gammage M D
University of Brimingham, UK.
Europace. 1999 Jan;1(1):49-54. doi: 10.1053/eupc.1998.0012.
Various mode-switching algorithms are available with different tachyarrhythmia detection criteria to be satisfied to initiate mode-switching. This study evaluated three different mode-switching algorithms in patients with paroxysmal atrial fibrillation.
Seventeen patients completed the study. Three mode-switching algorithms were downloaded as software into the pacemaker, each for 1 month in a single-blind, randomized sequence. The criteria to initiate mode-switching were: mean atrial rate ('standard'), '4-of-7' or '1-of-1' atrial intervals to exceed the atrial detection rate. Symptoms for each were measured using the Symptom Checklist Frequency and Severity index. The median number of mode-switch episodes increased from 20 for 'standard' to 39 for '4-of-7' (P=0.029 vs 'standard') and 103 for '1-of-1' (P=0.0012 vs 'standard') onset criteria. Median duration of episodes decreased from 2.5 min with 'standard' to 1.4 min with '4-of-7' and 0.4 min with '1-of-1' onset criteria. Frequency of symptoms was lower using '4-of-7' (18.2 +/- 12.0 vs 23 +/- 12.0, P=0.08) or '1-of-1' (20.4 +/- 12.4 vs 23 +/- 12.0, P=0.07) than 'standard' onset criteria. Severity of arrhythmia tended to be less with either '4-of-7' (16 +/- 10.4 vs 19.1 +/- 19.4, P=0.12) or '1-of-1' (17.5 +/- 10.3 vs 19.1 +/- 9.4, P=0.18) than with 'standard' onset criteria.
The more sensitive onset criteria for detection of atrial tachyarrhythmias were associated with lower frequency and severity of symptoms.
有多种模式切换算法，每种算法都有不同的快速性心律失常检测标准，以满足启动模式切换的条件。本研究评估了阵发性心房颤动患者的三种不同模式切换算法。
17例患者完成了本研究。将三种模式切换算法作为软件下载到起搏器中，以单盲、随机顺序，每种算法使用1个月。启动模式切换的标准为：平均心房率（“标准”）、“7中4”或“1中1”心房间期超过心房检测率。使用症状清单频率和严重程度指数测量每种算法的症状。模式切换发作的中位数从“标准”的20次增加到“7中4”的39次（与“标准”相比，P=0.029）和“1中1”的103次（与“标准”相比，P=0.0012）发作标准。发作的中位数持续时间从“标准”的2.5分钟降至“7中4”的1.4分钟和“1中1”发作标准的0.4分钟。使用“7中4”（18.2±12.0对23±12.0，P=0.08）或“1中1”（20.4±12.4对23±12.0，P=0.07）时症状频率低于“标准”发作标准。与“标准”发作标准相比，使用“7中4”（16±10.4对19.1±19.4，P=0.12）或“1中1”（17.5±10.3对19.1±9.4，P=0.18）时心律失常的严重程度往往较低。
检测房性快速性心律失常的更敏感发作标准与更低的症状频率和严重程度相关。
