单腔心房起搏：窦房结疾病的一种现实选择：对213例患者的长期随访研究

Single chamber atrial pacing: a realistic option in sinus node disease: a long-term follow-up study of 213 patients.

作者信息

Höijer Carl J, Höglund Peter, Schüller Hans, Brandt Johan

机构信息

Heart and Lung Division, Lund University Hospital, Lund, Sweden.

出版信息

Pacing Clin Electrophysiol. 2007 Jun;30(6):740-7. doi: 10.1111/j.1540-8159.2007.00744.x.

DOI:10.1111/j.1540-8159.2007.00744.x

PMID:17547606

Abstract

BACKGROUND

Despite several decades of experience with atrial pacing, many centers do not apply this mode to any greater extent, mainly because of concerns for the development of future atrioventricular (AV) block or atrial fibrillation. Recent studies have emphasized possible negative effects of right ventricular stimulation, even when AV-synchrony is preserved, and have thus given rise to renewed interest in single chamber atrial pacing for sinus node disease.

METHODS

This study presents the results of up to 19 years' follow-up of 213 patients with sinus node disease treated with atrial pacing with respect to survival and causes of death, development of atrial fibrillation and AV block, and total mode survival. Patients were divided into two groups: with or without associated atrial tachyarrhythmias at the time of implant. Results are given for all patients and for the two groups separately.

RESULTS

The mean follow-up time was 10.1 years. The survival of the entire group was lower after 10 years than that of an age and gender-matched general Swedish population. This was caused by patients with the brady-tachy syndrome (BT) having a significantly higher mortality rate than controls, whereas those with bradycardia only (B) had survival comparable to the general population. Permanent atrial fibrillation (AF) developed in 20% of patients and was significantly more common in patients with BT. The majority of patients with AF (78%) no longer needed any pacing, i.e., did not require ventricular stimulation due to slow ventricular rate. The annual incidence of high grade AV block was 1.8%. If patients with preexisting bundle branch block were excluded, the incidence was 1.6%. No fatal episode of AV block was seen. The overall mode survival at the end of follow-up was 75%, with 155 patients still with atrial pacemakers.

CONCLUSION

Atrial pacing is a safe and reliable mode of pacing in patients with sinus node disease, even in the very long-term.

摘要

背景

尽管心房起搏已有数十年的应用经验，但许多中心并未更广泛地采用这种起搏模式，主要是担心未来发生房室传导阻滞或心房颤动。近期研究强调了右心室起搏可能产生的负面影响，即便保持房室同步亦是如此，这因此再度引发了对窦房结疾病采用单腔心房起搏的兴趣。

方法

本研究呈现了213例接受心房起搏治疗的窦房结疾病患者长达19年的随访结果，内容涉及生存情况及死亡原因、心房颤动和房室传导阻滞的发生情况以及起搏模式总生存率。患者被分为两组：植入时伴有或不伴有房性快速性心律失常。分别给出了所有患者及两组患者的结果。

结果

平均随访时间为10.1年。10年后，整个研究组的生存率低于年龄和性别匹配的瑞典普通人群。这是由于慢快综合征（BT）患者的死亡率显著高于对照组，而仅患有心动过缓（B）的患者生存率与普通人群相当。20%的患者发生了永久性心房颤动（AF），且在BT患者中更为常见。大多数房颤患者（78%）不再需要任何起搏，即由于心室率缓慢无需心室起搏。高度房室传导阻滞的年发生率为1.8%。若排除既往存在束支传导阻滞的患者，发生率为1.6%。未观察到房室传导阻滞的致死性发作。随访结束时起搏模式总生存率为75%，有155例患者仍使用心房起搏器。