Schwaab B, Kindermann M, Schätzer-Klotz D, Berg M, Franow H, Fröhlig G, Schieffer H
Curschmann Klinik, Timmendorfer Strand, Germany.
Pacing Clin Electrophysiol. 2001 Nov;24(11):1585-95. doi: 10.1046/j.1460-9592.2001.01585.x.
In 19 patients paced and medicated for bradycardia tachycardia syndrome (BTS), AAIR and DDDR pacing were compared with regard to quality of life (QoL), atrial tachyarrhythmia (AFib), exercise tolerance, and left ventricular (LV)function. Patients had a PQ interval < or = 240 ms during sinus rhythm, no second or third degree AV block, no bundle branch block, or bifascicular block. In DDDR mode, AV delay was optimized using the aortic time velocity integral. After 3 months, QoL was assessed by questionnaires, patients were investigated by 24-hour Holter, cardiopulmonary exercise testing (CPX) was performed, and LV function was determined by echocardiography. QoL was similar in all dimensions, except dizziness, showing a significantly lower prevalence in AAIR mode. The incidence of AFib was 12 episodes in 2 patients with AAIR versus 22 episodes in 7 patients with DDDR pacing (P = 0.072). In AAIR mode, 164 events of second and third degree AV block were detected in 7 patients (37%) with pauses between 1 and 4 seconds. During CPX, exercise duration and work load were higher in AAIR than in DDDR mode (423+/-127 vs 402+/-102 s and 103+/-31 vs 96+/-27 Watt, P < 0.05). Oxygen consumption (VO2), was similar in both modes. During echocardiography, only deceleration of early diastolic flow velocity and early diastolic closure rate of the anterior mitral valve leaflet were higher in DDD than in AAI pacing (5.16+/-1.35 vs 3.56+/-0.95 m/s2 and 69.2+/-23 vs 54.1+/-26 mm/s, P < 0.05). As preferred pacing mode, 11 patients chose DDDR, 8 patients chose AAIR. Hence, AAIR and DDDR pacing seem to be equally effective in BTS patients. In view of a considerable rate of high degree AV block during AAIR pacing, DDDR mode should be preferred for safety reasons.
在19例因心动过缓-心动过速综合征（BTS）而接受起搏治疗和药物治疗的患者中，对AAIR起搏和DDDR起搏在生活质量（QoL）、房性快速心律失常（房颤）、运动耐量和左心室（LV）功能方面进行了比较。患者在窦性心律时PQ间期≤240毫秒，无二度或三度房室传导阻滞，无束支传导阻滞或双分支传导阻滞。在DDDR模式下，使用主动脉时间速度积分优化房室延迟。3个月后，通过问卷调查评估生活质量，通过24小时动态心电图对患者进行检查，进行心肺运动试验（CPX），并通过超声心动图测定左心室功能。除头晕外，所有维度的生活质量相似，在AAIR模式下头晕的发生率显著较低。AAIR起搏的2例患者发生房颤12次，而DDDR起搏的7例患者发生房颤22次（P = 0.072）。在AAIR模式下，7例患者（37%）检测到164次二度和三度房室传导阻滞事件，停搏时间在1至4秒之间。在CPX期间，AAIR模式下的运动持续时间和工作量高于DDDR模式（423±127秒对402±102秒，103±31瓦对96±27瓦，P<0.05）。两种模式下的耗氧量（VO2）相似。在超声心动图检查中，只有DDD起搏时二尖瓣前叶舒张早期血流速度的减速度和舒张早期关闭速度高于AAI起搏（5.16±1.35对3.56±0.95米/秒²，69.2±23对54.1±26毫米/秒，P<0.05）。作为首选起搏模式，11例患者选择DDDR，8例患者选择AAIR。因此，AAIR起搏和DDDR起搏在BTS患者中似乎同样有效。鉴于AAIR起搏期间高度房室传导阻滞的发生率较高，出于安全考虑，应首选DDDR模式。
