Saba Magdi M, Donahue Timothy P, Panotopoulos Panagiotis T H, Ibrahim Salma S, Abi-Samra Freddy M
Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
Pacing Clin Electrophysiol. 2005 Nov;28(11):1203-7. doi: 10.1111/j.1540-8159.2005.50189.x.
The long-term significance of ventricular pauses of > or =3.0 seconds observed on Holter monitor is unclear, as previously conducted retrospective studies have been poorly controlled. We compared the prognosis of patients with pauses > or =3.0 seconds on Holter monitor with a well-matched control group without such pauses.
Scanning the Holter database at Ochsner Clinic (n = 11,730; January 1998 to June 2003) for pauses > or =3.0 seconds identified 70 patients (pause group). Of those, 29 (37.1%) received a permanent pacemaker (PPM group) and 41 (62.9%) did not (No-PPM group). For each No-PPM patient, two patients without pauses (<2.0 seconds) exactly matched for age, sex, ejection fraction (EF), rhythm, and duration of follow-up were randomly chosen from the Holter database (control group, n = 82) and survival of the two groups was compared.
Mean age was 72.5 +/- 15.0 years, mean EF was 52.2 +/- 12.7%, and 68.3% were men. Mean follow-up was 2.2 years (0.5-4.5 years). There was no difference in survival between the No-PPM and the control groups (82.9% vs 84.1%, P = NS). Compared with the PPM group, pauses in the No-PPM group were more commonly asymptomatic, nocturnal, and due to sinus pauses or atrial fibrillation (AF) with slow ventricular response.
Pauses in ventricular electrical activity > or =3 seconds on Holter monitor due to sinus pauses or AF with slow ventricular response are not predictive of heightened mortality.
动态心电图监测中观察到的心室停搏≥3.0秒的长期意义尚不清楚，因为之前进行的回顾性研究控制不佳。我们将动态心电图监测中出现≥3.0秒停搏的患者的预后与匹配良好的无此类停搏的对照组进行了比较。
在奥施纳诊所的动态心电图数据库（n = 11,730；1998年1月至2003年6月）中筛查≥3.0秒的停搏，确定了70例患者（停搏组）。其中，29例（37.1%）接受了永久性起搏器植入（PPM组），41例（62.9%）未接受（非PPM组）。对于每例非PPM患者，从动态心电图数据库中随机选择两名无停搏（<2.0秒）、年龄、性别、射血分数（EF）、心律和随访时间完全匹配的患者（对照组，n = 82），并比较两组的生存率。
平均年龄为72.5±15.0岁，平均EF为52.2±12.7%，男性占68.3%。平均随访时间为2.2年（0.5 - 4.5年）。非PPM组和对照组的生存率无差异（82.9%对84.1%，P = 无显著性差异）。与PPM组相比，非PPM组的停搏更常见于无症状、夜间发作，且由窦性停搏或伴有缓慢心室反应的心房颤动（AF）引起。
动态心电图监测中因窦性停搏或伴有缓慢心室反应的AF导致的心室电活动停搏≥3秒并不能预测死亡率升高。
