Gillis Anne M
Cardiovascular Research Group, The University of Calgary and Division of Cardiology, Calgary Health Region, Calgary, Alberta, Canada.
Card Electrophysiol Rev. 2003 Dec;7(4):312-4. doi: 10.1023/B:CEPR.0000023130.12304.e4.
The optimal pacing mode for patients with paroxysmal atrial fibrillation (AF) following AV junction ablation remains the subject of some debate. Recent clinical trials have not demonstrated a superior advantage of maintenance of sinus rhythm over the rate control approach. However, clinical trials in pacemaker populations have demonstrated that physiologic pacing reduces the probability of paroxysmal and persistent AF compared to ventricular pacing. In the second phase of the PA(3) study, patients were randomized to DDDR versus VDD pacing in a cross over study design. Of the 67 patients randomized, 42% developed permanent AF within one year following ablation. AF frequency and burden increases early following AV junction ablation suggesting that ventricular pacing even in an atrial synchronous mode promotes AF. Given the high probability of permanent AF developing early following ablation, VVIR pacing appears to be the appropriate pacing mode for symptomatic patients undergoing total AV junction ablation.
对于房室交界区消融术后的阵发性心房颤动（AF）患者，最佳起搏模式仍存在一些争议。近期的临床试验并未证明维持窦性心律比心率控制方法具有更大优势。然而，针对起搏器人群的临床试验表明，与心室起搏相比，生理性起搏可降低阵发性和持续性房颤的发生概率。在PA(3)研究的第二阶段，采用交叉研究设计将患者随机分为DDDR起搏组和VDD起搏组。在随机分组的67例患者中，42%在消融术后1年内发展为永久性房颤。房室交界区消融术后早期房颤的发作频率和负荷增加，这表明即使是心房同步模式下的心室起搏也会促进房颤发生。鉴于消融术后早期发生永久性房颤的可能性很高，VVIR起搏似乎是接受完全性房室交界区消融的有症状患者的合适起搏模式。
