Swiatecka G, Sielski S, Wilczek R, Jackowiak D, Kubica J, Raczak G
II Department of Cardiology, Medical University, Gdańsk, Poland.
Pacing Clin Electrophysiol. 1992 Nov;15(11 Pt 2):2074-6. doi: 10.1111/j.1540-8159.1992.tb03024.x.
In sinoatrial node disease (SND) atrial pacing may be limited by progression of AV block. The incidence of AV block after AAI systems implantation range, according to various authors, from 0% to 12%. The aim of this study was to examine the AV conduction disturbances that forced a change in the mode of pacing in patients with AAI pacemakers. The information was collected retrospectively from a cohort of 122 patients. The follow-up period ranged from 5 to 83 months (mean = 35). Among these patients there were 37 with sinus bradycardia and 85 with bradycardia-tachycardia syndrome. Their mean age was 63 years. Before AAI pacemaker insertion, all patients had normal AV conduction on 12-lead ECG, and all but five had a Wenckebach cycle length shorter than 500 msec. Seven out of these 122 patients (5.7%) developed symptomatic conduction disturbances (second-degree type I AV block in five, second degree type II AV block in one, and third-degree AV block in one), necessitating a change from AAI to another mode of pacing. We conclude that progression of AV block after atrial pacemaker implantation in patients with SND is infrequent and mild in the majority of cases. Intraventricular disturbances such as left anterior hemiblock represent contraindication to AAI pacing particularly in patients who may be in need of antiarrhythmic drugs.
在窦房结疾病（SND）中，心房起搏可能会受到房室传导阻滞进展的限制。根据不同作者的研究，AAI系统植入后房室传导阻滞的发生率在0%至12%之间。本研究的目的是检查AAI起搏器患者中导致起搏模式改变的房室传导障碍。信息是从122例患者的队列中回顾性收集的。随访期为5至83个月（平均 = 35个月）。这些患者中有37例患有窦性心动过缓，85例患有心动过缓-心动过速综合征。他们的平均年龄为63岁。在植入AAI起搏器之前，所有患者在12导联心电图上的房室传导均正常，除5例患者外，所有患者的文氏周期长度均短于500毫秒。这122例患者中有7例（5.7%）出现了有症状的传导障碍（5例为一度房室传导阻滞，1例为二度房室传导阻滞，1例为三度房室传导阻滞），需要从AAI起搏模式改为另一种起搏模式。我们得出结论，SND患者植入心房起搏器后房室传导阻滞的进展在大多数情况下并不常见且程度较轻。室内传导障碍如左前分支阻滞是AAI起搏的禁忌证，尤其是对于可能需要抗心律失常药物的患者。
