Feldman S, Glikson M, Kaplinsky E
Heart Institute, Chaim Sheba Medical Center, Tel Aviv, Israel.
Pacing Clin Electrophysiol. 1992 Nov;15(11 Pt 2):2037-40. doi: 10.1111/j.1540-8159.1992.tb03017.x.
A retrospective study was carried out on 36 patients (33 males and 3 females) to determine the incidence of VVI pacemaker dependency following coronary artery bypass surgery. Pacemaker dependency was defined as the presence of pacemaker activity when pacing rate was programmed at 50 beats/min and/or when no hemodynamic adequate rhythm was present during pulse generator replacement. The patients were divided into two groups: (group I) 26 patients with complete atrioventricular (AV) block developing in the early postoperative period. In most of them a pacemaker was implanted up to 3 weeks following surgery (range 2 days to 1 year); (group II) ten patients in whom the indication for pacemaker implantation was sick sinus syndrome with sinus arrest and/or tachy-bradycardia. These patients underwent pacemaker implantation at varying periods of time following surgery (range 12 days to 4 years). Unipolar endocardial leads with VVI programmable pacemakers were implanted in all patients included in this study. Mean follow-up time was 3 years. In group I the pacemaker dependency rate was 65%, whereas in group II it was 30% throughout the follow-up period. It is concluded that the low incidence of pacemaker dependency in patients who undergo pacemaker implantation after coronary bypass surgery necessitates frequent evaluation in the nondependent patient, in order to reassess the need for the pacemaker before pulse generator replacement. Such reassessment should probably include prolonged ambulatory monitoring as well as invasive evaluation of the conduction system, if avoidance of pulse generator replacement is considered.
对36例患者（33例男性和3例女性）进行了一项回顾性研究，以确定冠状动脉搭桥手术后VVI起搏器依赖的发生率。起搏器依赖被定义为当起搏频率设定为50次/分钟时起搏器活动存在，和/或在更换脉冲发生器期间不存在血流动力学上足够的心律时起搏器活动存在。患者被分为两组：（第一组）26例在术后早期发生完全性房室传导阻滞的患者。他们中的大多数在手术后长达3周（范围为2天至1年）植入了起搏器；（第二组）10例起搏器植入指征为病态窦房结综合征伴窦性停搏和/或心动过缓-心动过速的患者。这些患者在手术后不同时间接受了起搏器植入（范围为12天至4年）。本研究纳入的所有患者均植入了带有VVI可编程起搏器的单极心内膜导线。平均随访时间为3年。在第一组中，起搏器依赖率为65%，而在第二组中，在整个随访期间为30%。得出的结论是，冠状动脉搭桥手术后接受起搏器植入的患者中起搏器依赖的低发生率使得有必要对非依赖患者进行频繁评估，以便在更换脉冲发生器之前重新评估对起搏器的需求。如果考虑避免更换脉冲发生器，这种重新评估可能应包括延长动态监测以及对传导系统进行有创评估。
