Yang Alexander, Bitzen Alexander, Schwab Jörg Otto, Schrickel Jan, Lüderitz Berndt, Lewalter Thorsten
Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn.
Herz. 2005 Dec;30(8):733-42. doi: 10.1007/s00059-005-2665-x.
Several prospective randomized clinical trials have reported that atrial-based "physiological" pacing is associated with a lower incidence of paroxysmal and permanent atrial fibrillation than single-chamber ventricular pacing in patients with conventional pacemaker indication. Whether atrial pacing itself is antiarrhythmic remains still uncertain. By contrast, right ventricular pacing is considered to beget atrial fibrillation, even in preserved AV synchrony during dual-chamber pacing. A number of clinical trials investigated the impact of sitespecific atrial pacing and advanced atrial pacing algorithms on the secondary prevention of atrial fibrillation. Multisite pacing (dual-site right atrial or biatrial pacing) was demonstrated to add only minimal benefit for the prevention of atrial fibrillation. By contrast, in some studies septal pacing and specific atrial pacing algorithms were reported to reduce the recurrence of atrial fibrillation in selected patients. At present, however, it remains unclear how to identify these patients. In clinical practice, the effectiveness of specific atrial pacing algorithms and/or septal pacing has to be tested out in the individual case. These therapeutic options should be considered in patients with a conventional indication for antibradycardia pacing and, additionally, symptomatic atrial fibrillation.
多项前瞻性随机临床试验报告称，在有传统起搏器适应证的患者中，基于心房的“生理性”起搏与阵发性和永久性心房颤动的发生率低于单腔心室起搏相关。心房起搏本身是否具有抗心律失常作用仍不确定。相比之下，右心室起搏被认为会引发心房颤动，即使在双腔起搏期间房室同步保持完好的情况下也是如此。多项临床试验研究了部位特异性心房起搏和先进的心房起搏算法对心房颤动二级预防的影响。多部位起搏（双部位右心房或双心房起搏）被证明对预防心房颤动仅增加极小的益处。相比之下，在一些研究中，据报道间隔起搏和特定的心房起搏算法可降低部分患者心房颤动的复发率。然而，目前尚不清楚如何识别这些患者。在临床实践中，特定的心房起搏算法和/或间隔起搏的有效性必须在个案中进行检验。对于有抗心动过缓起搏传统适应证且伴有症状性心房颤动的患者，应考虑这些治疗选择。
