Olshansky Brian, Day John D, Lerew Darin R, Brown Scott, Stolen Kira Q
University of Iowa Hospitals, Iowa City, IA 52242, USA.
Heart Rhythm. 2007 Jul;4(7):886-91. doi: 10.1016/j.hrthm.2007.03.031. Epub 2007 Apr 6.
Excessive right ventricular (RV) pacing has been associated with adverse clinical outcomes in patients receiving pacemakers or implantable cardioverter-defibrillators (ICDs). It remains uncertain how much RV pacing is clinically deleterious.
This retrospective analysis assessed the relationship between the amount of RV pacing and the composite of all-cause mortality and heart failure hospitalization in all patients programmed DDDR in the Inhibition of Unnecessary RV Pacing with AV Search Hysteresis in ICDs (INTRINSIC RV) study.
Seven hundred fifteen patients consistently programmed to DDDR mode throughout follow-up (mean 11.6 months) were examined. The relationship between RV pacing tier and death and heart failure hospitalization was determined and compared with patient characteristics.
Across the six RV pacing tiers, patients differed significantly with respect to age, clinical history of ventricular tachycardia, atrial fibrillation, and atrial flutter, and amiodarone use. When controlling for these baseline differences, the best outcome was seen in the group with RV pacing between 10% and 19% (2.8% event rate; n = 106). Increasing levels of RV pacing were generally predictive of higher event rates (death or heart failure hospitalization; P = 0.003), except for the group (n = 344) with the least amount of RV pacing (0-9%). This group exhibited poorer outcomes than otherwise expected (P = 0.016), with 8.1% of these patients experiencing an event.
High levels of RV pacing are associated with heart failure hospitalization and mortality in a large ICD population. However, ICD patients with some RV pacing (10%-19%) exhibit lower event rates compared with those with very low levels (0-9%), possibly due to the physiologically appropriate nature of that RV pacing.
在接受起搏器或植入式心脏复律除颤器（ICD）治疗的患者中，右心室（RV）过度起搏与不良临床结局相关。临床上，多少右心室起搏会产生有害影响仍不确定。
在ICD中应用房室搜索迟滞抑制不必要的右心室起搏（INTRINSIC RV）研究中，这项回顾性分析评估了所有程控为DDDR模式的患者的右心室起搏量与全因死亡率和心力衰竭住院率的综合情况之间的关系。
对715例在整个随访期间（平均11.6个月）持续程控为DDDR模式的患者进行了检查。确定右心室起搏分层与死亡及心力衰竭住院之间的关系，并与患者特征进行比较。
在六个右心室起搏分层中，患者在年龄、室性心动过速、心房颤动和心房扑动的临床病史以及胺碘酮使用情况方面存在显著差异。在控制这些基线差异后，右心室起搏率在10%至19%之间的组预后最佳（事件发生率为2.8%；n = 106）。除了右心室起搏量最少（0 - 9%）的组（n = 344）外，右心室起搏水平升高通常预示着更高的事件发生率（死亡或心力衰竭住院；P = 0.003）。该组的预后比预期的更差（P = 0.016），其中8.1%的患者发生了事件。
在大量ICD患者中，高水平的右心室起搏与心力衰竭住院和死亡率相关。然而，与右心室起搏水平极低（0 - 9%）的患者相比，有一定右心室起搏（10% - 19%）的ICD患者事件发生率较低，这可能是由于该右心室起搏具有生理上的适当性。
