Parry G, Malbut K, Dark J H, Bexton R S
Department of Cardiology, Freeman Hospital, Newcastle upon Tyne.
Br Heart J. 1992 Aug;68(2):195-8. doi: 10.1136/hrt.68.8.195.
To investigate the response of the transplanted heart to different pacing modes and to synchronisation of the recipient and donor atria in terms of cardiac output at rest.
Doppler derived cardiac output measurements at three pacing rates (90/min, 110/min and 130/min) in five pacing modes: right ventricular pacing, donor atrial pacing, recipient-donor synchronous pacing, donor atrial-ventricular sequential pacing, and synchronous recipient-donor atrial-ventricular sequential pacing.
11 healthy cardiac transplant recipients with three pairs of epicardial leads inserted at transplantation.
Donor atrial pacing (+11% overall) and donor atrial-ventricular sequential pacing (+8% overall) were significantly better than right ventricular pacing (p < 0.001) at all pacing rates. Synchronised pacing of recipient and donor atrial segments did not confer additional benefit in either atrial or atrial-ventricular sequential modes of pacing in terms of cardiac output at rest at these fixed rates.
Atrial pacing or atrial-ventricular sequential pacing appear to be appropriate modes in cardiac transplant recipients. Synchronisation of recipient and donor atrial segments in this study produced no additional benefit. Chronotropic competence in these patients may, however, result in improved exercise capacity and deserves further investigation.
研究移植心脏对不同起搏模式以及受体与供体心房同步化在静息心输出量方面的反应。
在五种起搏模式下，以三种起搏频率（90次/分钟、110次/分钟和130次/分钟）通过多普勒测量心输出量，这五种起搏模式分别为：右心室起搏、供体心房起搏、受体 - 供体同步起搏、供体心房 - 心室顺序起搏以及同步的受体 - 供体心房 - 心室顺序起搏。
11名健康的心脏移植受者，在移植时插入了三对心外膜导线。
在所有起搏频率下，供体心房起搏（总体增加11%）和供体心房 - 心室顺序起搏（总体增加8%）均显著优于右心室起搏（p < 0.001）。就这些固定频率下的静息心输出量而言，受体和供体心房节段的同步起搏在心房或心房 - 心室顺序起搏模式中均未带来额外益处。
心房起搏或心房 - 心室顺序起搏似乎是心脏移植受者的合适起搏模式。本研究中受体和供体心房节段的同步化未产生额外益处。然而，这些患者的变时性功能可能会导致运动能力改善，值得进一步研究。
