Lau C P, Tai Y T, Li J P, Chung F L, Sung S, Yamamoto A
Department of Medicine, University of Hong Kong, Queen Mary Hospital.
Pacing Clin Electrophysiol. 1992 Nov;15(11 Pt 2):1894-900. doi: 10.1111/j.1540-8159.1992.tb02989.x.
Although ventricular rate adaptive pacing (VVIR) improves exercise capacity and cardiac output compared to constant rate ventricular pacing (VVI), this pacing mode does not provide benefit of atrioventricular (AV) synchrony. We evaluated the use of a custom-built VDDR pacing system using a single pass, ventricular lead, which detects endocavity P wave using a pair of diagonally arranged atrial bipolar (DAB) electrodes. In the VDDR mode, AV synchrony is enabled and the P wave rate is used in conjunction with an accelerometer based activity sensor for rate adaptive pacing. A VDDR pacemaker was implanted in three patients with complete AV block (mean age 63 +/- 1 year) and the mean implantation time was 29 minutes. Mean P wave amplitude was 2.4 mV (1.2-4.2 mV) at implantation and telemetered P wave amplitude was stable over a follow-up of 6 months. At a sensitivity of 0.2 mV, stable P wave sensing was observed during breathing maneuvers, arm swinging, myopotential induction, and Holter recording. Paired exercise tests performed in the VDDR and VVIR modes showed higher cardiac output at rest, during exercise, and in the recovery period in the VDDR pacing mode. Thus VDDR pacing using a single pass lead is superior to VVIR pacing by enabling P synchronous ventricular pacing without adding to the complexity of implantation.
尽管与固定频率心室起搏（VVI）相比，心室率适应性起搏（VVIR）可提高运动能力和心输出量，但这种起搏模式无法提供房室（AV）同步的益处。我们评估了一种定制的VVDR起搏系统的使用情况，该系统采用单根心室导线，通过一对对角排列的心房双极（DAB）电极检测心腔内P波。在VVDR模式下，可实现房室同步，P波频率与基于加速度计的活动传感器结合用于频率适应性起搏。为三名完全性房室传导阻滞患者（平均年龄63±1岁）植入了VVDR起搏器，平均植入时间为29分钟。植入时平均P波振幅为2.4 mV（1.2 - 4.2 mV），在6个月的随访期间，遥测的P波振幅稳定。在灵敏度为0.2 mV时，在呼吸动作、手臂摆动、肌电位诱发和动态心电图记录期间均观察到稳定的P波感知。在VVDR和VVIR模式下进行的配对运动测试显示，在静息、运动和恢复期间，VVDR起搏模式下心输出量更高。因此，使用单根导线的VVDR起搏通过实现P波同步心室起搏且不增加植入复杂性，优于VVIR起搏。
