Kolettis T M, Miller H C, Boon N A
Department of Cardiology, Royal Infirmary of Edinburgh, Scotland, England.
Pacing Clin Electrophysiol. 1990 May;13(5):625-30. doi: 10.1111/j.1540-8159.1990.tb02079.x.
The records of 100 patients with permanent atrial pacemakers implanted over a 7-year period were reviewed to assess the role and results of this mode of pacing. Indications for pacing were sick sinus syndrome in 91, carotid sinus hypersensitivity in 3, and use of an antitachycardia device in 6 patients. The mean follow-up period was 32.9 months. Symptomatic relief was good. Lead dislodgment occurred in 11 patients (usually in the first week). Threshold rises not amenable to reprogramming occurred in three patients and loss of sensing occurred in seven patients but only one required intervention. Overall, 21 patients required reoperation. The type of lead did not influence the need for reoperation that appeared to be related to the experience of the operator. Complete atrioventricular block occurred in three patients, two of whom had carotid sinus hypersensitivity and one had sick sinus syndrome. Chronic atrial fibrillation occurred in five patients, none of whom required revision of the pacemaker system. Atrial pacing is a satisfactory pacing mode in patients with sick sinus syndrome. Provided satisfactory atrioventricular conduction has been shown by incremental atrial pacing to at least 120 beats/min and carotid hypersensitivity is absent, progression to complete atrioventricular block is uncommon. Greater implanting skills are required for good results.
回顾了100例在7年期间植入永久性心房起搏器患者的记录，以评估这种起搏方式的作用和效果。起搏指征为病态窦房结综合征91例、颈动脉窦过敏3例、使用抗心动过速装置6例。平均随访期为32.9个月。症状缓解良好。11例患者发生电极脱位（通常在第一周）。3例患者出现无法通过重新编程解决的阈值升高，7例患者出现感知丧失，但仅1例需要干预。总体而言，21例患者需要再次手术。电极类型不影响再次手术的需求，再次手术需求似乎与术者经验有关。3例患者发生完全性房室传导阻滞，其中2例有颈动脉窦过敏，1例有病态窦房结综合征。5例患者发生慢性心房颤动，均无需修订起搏器系统。对于病态窦房结综合征患者，心房起搏是一种令人满意的起搏方式。如果通过递增性心房起搏显示房室传导良好，至少达到120次/分钟，且无颈动脉过敏，则进展为完全性房室传导阻滞并不常见。要取得良好效果需要更高的植入技术。
