Huang Max, Krahn Andrew D, Yee Raymond, Klein George J, Skanes Allan C
Division of Cardiology, University of Western Ontario, London Ontario Canada.
Pacing Clin Electrophysiol. 2003 Dec;26(12):2230-4. doi: 10.1111/j.1540-8159.2003.00352.x.
VDD pacing provides the physiological benefits of atrioventricular synchronous pacing with the convenience of a single lead system, but is hampered by uncertainty regarding long-term atrial sensing and potential development of sinus node disease. To examine the long-term reliability and complication rates of VDD pacing, we compared the outcome of 112 consecutive patients (age 70 +/- 13 years, 59% male) with symptomatic AV block who received a single pass bipolar VDD system to 80 patients (age 63 +/- 16 years, 70% male) who received DDD pacing for the same indication. All patients were judged to have intact sinus node function based on submitted ECGs and monitoring results at the time of implant. Implant time was reduced in VDD patients compared to DDD patients (63 +/- 20 vs 97 +/- 36 minutes, P < 0.0001). Implant complications occurred in 5 (6%) DDD patients compared to 3 (3%) VDD patients (P = 0.15). The implant P wave was lower with VDD pacing compared to DDD patients (2.91 +/- 1.48 vs 4.0 +/- 1.7 mV, P < 0.0001), but remained stable during long-term follow-up in both groups. During 17.7 +/- 10.0 months of follow-up in the VDD group, only 2 VDD patients were reprogrammed to VVIR mode, compared to 3 DDD patients. Physiological atrioventricular activation was maintained in 94%-99% of beats throughout the follow-up period in the VDD group. VDD pacing is an excellent strategy for treatment of patients with symptomatic AV block. The lower cost, high reliability, and abbreviated implantation time suggest that VDD pacing is a viable alternative to DDD pacing in patients with high-degree AV block and normal sinus node function.
VDD起搏提供了房室同步起搏的生理益处，且具备单导联系统的便利性，但长期心房感知的不确定性以及窦房结疾病的潜在发展对其造成了阻碍。为了研究VDD起搏的长期可靠性和并发症发生率，我们将112例有症状房室传导阻滞的连续患者（年龄70±13岁，男性占59%）接受单极双极VDD系统的结果与80例因相同适应证接受DDD起搏的患者（年龄63±16岁，男性占70%）进行了比较。根据植入时提交的心电图和监测结果，所有患者均被判定窦房结功能完好。与DDD患者相比，VDD患者的植入时间缩短（63±20分钟对97±36分钟，P<0.0001）。5例（6%）DDD患者发生植入并发症，而VDD患者为3例（3%）（P=0.15）。与DDD患者相比，VDD起搏时植入的P波更低（2.91±1.48mV对4.0±1.7mV，P<0.0001），但两组在长期随访期间均保持稳定。在VDD组17.7±10.0个月的随访中，只有2例VDD患者被重新程控为VVIR模式，而DDD患者为3例。在VDD组的整个随访期间，94%-99%的搏动维持了生理性房室激活。VDD起搏是治疗有症状房室传导阻滞患者的一种极佳策略。成本较低、可靠性高以及植入时间缩短表明，对于高度房室传导阻滞且窦房结功能正常的患者，VDD起搏是DDD起搏的一种可行替代方案。
