Taieb Jerome, Benchaa Tewfik, Foltzer Eric, Coste Andre, Tarlet Jean-Michel, Jouve Bernard, Rahal Youssef, Pochon Pascale, Moudni Fatima, Barnay Claude
Service de Cardiologie et des Maladies Vasculaires, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France.
Pacing Clin Electrophysiol. 2002 Jun;25(6):929-35. doi: 10.1046/j.1460-9592.2002.t01-1-00929.x.
The aim of the study was to evaluate, in recipients of biventricular pacing systems, the risk of asystole due to ventricular pacing inhibition by sensing the left atrial signals by the LV lead at conventional sensitivity. Long-term ventricular sensitivity was programmed at > or = 4 m V in 17 consecutive recipients of ventricular resynchronization systems implanted for chronic management of congestive heart failure. Ventricular pacing inhibition due to AV cross-talk on spontaneous left atrial electrogram (AVCSA) was tested at a 2 mV ventricular sensitivity immediately after implantation of the stimulation system and 1 month later. Pacemaker dependence was also tested during temporary VVI pacing at a rate of 30 beats/min. AVCSA was observed in three patients. It was present on the day of implantation in one patient, and developed within the first month in two others. Asystole was observed in two of the three cases of AVCSA. Three pacemaker nondependent patients at the time of system implantation had become pacemaker dependent at 1 month. AVCSA was observed only with LV leads positioned in the great cardiac vein. In conclusion, asystole due to AVCSA was observed in 11% of recipients of ventricular resynchronization stimulation systems. Care should be taken in these patients to minimize the risk of atrial sensing by the LV lead, preferably avoiding its placement in the great cardiac vein. This phenomenon could be eliminated by the programmability of a right ventricular only sensing configuration.
本研究的目的是评估在双心室起搏系统接受者中，左室电极以常规灵敏度感知左房信号导致心室起搏抑制而出现心脏停搏的风险。17例因慢性充血性心力衰竭植入心室再同步系统的连续患者，将长期心室灵敏度程控为≥4 mV。在刺激系统植入后即刻及1个月后，以2 mV的心室灵敏度测试因自发左房电图上的房室串扰（AVCSA）导致的心室起搏抑制情况。还在以30次/分的速率进行临时VVI起搏期间测试起搏器依赖情况。3例患者观察到AVCSA。1例患者在植入当天出现，另外2例在第一个月内出现。3例AVCSA患者中有2例观察到心脏停搏。3例系统植入时不依赖起搏器的患者在1个月时变为依赖起搏器。仅在左室电极置于大心静脉时观察到AVCSA。总之，心室再同步刺激系统接受者中11%观察到因AVCSA导致的心脏停搏。对于这些患者应注意尽量降低左室电极感知心房的风险，最好避免将其置于大心静脉。通过仅右心室感知配置的程控可消除这种现象。
