Boriani Giuseppe, Padeletti Luigi, Santini Massimo, Gulizia Michele, Orazi Serafino, Botto GianLuca, Capucci Alessandro, Biffi Mauro, Martignani Cristian, Ricci Renato, Vimercati Marco, DiStefano Paola, Grammatico Andrea
Institute of Cardiology, University of Bologna and Azienda Ospedaliera S. Orsola-Malpighi, Bologna, Italy.
Am Heart J. 2007 Jul;154(1):193-200. doi: 10.1016/j.ahj.2007.04.001.
In sinus node disease (SND) atrial tachyarrhythmias (ATs) may frequently occur, after implant of a pacemaker for bradycardia, and are to be managed by rate or rhythm control.
We evaluated ventricular heart rate (HR) during AT, AT-related symptoms and hospitalizations in 333 patients who received DDDRP pacemakers for SND.
In days with 24 hours of AT, mean daily HR during AT was > 80, 90, 100, 110, and 120 beats per minute (bpm) in 191 (57%), 114 (34%), 55 (16%), 23 (7%), and 11 (3%) patients, respectively. The proportion of patients with a mean daily HR > 80 bpm during AT despite the use of rate control agents was 28% among patients treated with calcium-channel blockers, 43% with digoxin, 49% with a combination of agents, 54% with amiodarone, 64% with sotalol, and 69% with beta blockers. Patients with HR > 100 bpm experienced a higher prevalence of both AT-related hospitalizations and cardiovascular hospitalizations than those with HR < or = 100 bpm (36% vs 21%, P = .013; 42% vs 28%, P = .003) and a significantly higher number of AT-related symptoms (1.8 +/- 0.9 vs 1.4 +/- 1.0, P = .008).
Limited attention has been dedicated to rate control in patients with pacemaker. This is the first study to evaluate the prevalence and implications of inappropriate rate control in patients with pacemaker. We found that in a substantial proportion of patients with SND who have recurrent ATs despite pacing, mean daily HR during AT is high and that these patients present increased hospitalizations and more symptoms, thus suggesting the need to improve rate control.
在窦房结疾病（SND）中，心房快速性心律失常（ATs）在植入用于治疗心动过缓的起搏器后可能频繁发生，需要通过心率或节律控制来处理。
我们评估了333例因SND接受DDDRP起搏器治疗的患者在发生AT期间的心室心率（HR）、与AT相关的症状及住院情况。
在有24小时AT发作的日子里，AT期间平均每日心率>80、90、100、110和120次/分钟（bpm）的患者分别有191例（57%）、114例（34%）、55例（16%）、23例（7%）和11例（3%）。尽管使用了心率控制药物，但在发生AT期间平均每日心率>80 bpm的患者比例在接受钙通道阻滞剂治疗的患者中为28%，地高辛治疗的患者中为43%，联合用药的患者中为49%，胺碘酮治疗的患者中为54%，索他洛尔治疗的患者中为64%，β受体阻滞剂治疗的患者中为69%。心率>100 bpm的患者与AT相关的住院率和心血管住院率均高于心率≤100 bpm的患者（36%对21%，P = 0.013；42%对28%，P = 0.003），且与AT相关的症状数量显著更多（1.8±0.9对1.4±1.0，P = 0.008）。
起搏器患者的心率控制受到的关注有限。这是第一项评估起搏器患者心率控制不当的患病率及其影响的研究。我们发现，在相当一部分尽管已起搏但仍反复发生AT的SND患者中，AT期间平均每日心率较高，且这些患者的住院率增加、症状更多，因此提示需要改善心率控制。
