Grimm W, Langenfeld H, Maisch B, Kochsiek K
University Hospital of Internal Medicine, Würzburg, Federal Republic of Germany.
Pacing Clin Electrophysiol. 1990 Dec;13(12 Pt 2):2086-90. doi: 10.1111/j.1540-8159.1990.tb06947.x.
Only few data are available about the course of symptoms, cardiac diseases, and spontaneous rhythm in pacemaker patients. Therefore, we followed the course of 308 paced patients (age 72 +/- 11 years) with a mean implantation time of 63 +/- 45 months.
The symptom triad of syncope, dizziness, and dyspnea improved remarkably in 93% of patients. Thirty-nine percent suffered from coronary heart disease. The risk factors of hypertension (47%), nicotine (37%), and diabetes mellitus (25%) were found significantly more often than in a normal population with the same age and sex profile. In VVI paced patients with sick sinus syndrome (SSS, n = 67) atrial fibrillation (AF) occurred significantly more often (42%) than in patients with AV block (n = 80, 23%, P less than 0.05). Only one out of 41 DDD paced patients showed AF at follow-up. VVI stimulation seems to favor AF due to retrograde conduction in SSS. Only 3% of patients with SSS developed second- or third-degree AV block. Therefore, atrial pacing is preferable in most patients with SSS.
关于起搏器患者的症状病程、心脏疾病和自主心律，仅有少量数据可用。因此，我们对308例接受起搏治疗的患者（年龄72±11岁）进行了随访，平均植入时间为63±45个月。
93%的患者晕厥、头晕和呼吸困难这一症状三联征有显著改善。39%的患者患有冠心病。高血压（47%）、吸烟（37%）和糖尿病（25%）等危险因素的出现频率明显高于具有相同年龄和性别分布的正常人群。在患有病态窦房结综合征（SSS，n = 67）的VVI起搏患者中，心房颤动（AF）的发生率（42%）显著高于房室传导阻滞患者（n = 80，23%，P < 0.05）。在41例DDD起搏患者中，随访时仅有1例出现AF。由于SSS中的逆向传导，VVI刺激似乎有利于AF的发生。仅3%的SSS患者发生二度或三度房室传导阻滞。因此，大多数SSS患者首选心房起搏。
