Oldroyd K G, Rae A P, Carter R, Wingate C, Cobbe S M
Department of Medical Cardiology, Royal Infirmary, Glasgow.
Br Heart J. 1991 Apr;65(4):188-93. doi: 10.1136/hrt.65.4.188.
To compare the effects of dual chamber pacing (DDD) and ventricular rate adaptive pacing (activity sensing) (VVIR) in patients with complete heart block.
Double blind crossover comparison with one month in each pacing mode.
10 consecutive patients aged 23-74 presenting with complete anterograde atrioventricular block at rest and on exercise and with an intact atrial rate response received Synergyst I (Medtronic) pacemakers.
Symptom scores, maximal exercise performance on a treadmill, and the plasma concentrations of atrial natriuretic peptide, adrenaline, and noradrenaline.
No significant differences were identified between pacing modes in symptom scores for dyspnoea, fatigue, and mood disturbance; exercise time; and maximal oxygen consumption. One patient with intact ventriculoatrial conduction developed pacemaker syndrome during VVIR pacing. Resting plasma concentrations of atrial natriuretic peptide were raised in complete heart block and were restored to normal by DDD pacing but not by VVIR pacing. Resting plasma catecholamine concentrations were normal in complete heart block and in both pacing modes. During exercise the increase in the concentrations of all three hormones was similar in both pacing modes.
In patients with complete anterograde and retrograde atrioventricular block, symptoms and maximal exercise performance were no better during DDD than during VVIR pacing.
比较双腔起搏（DDD）和心室率适应性起搏（活动感知）（VVIR）对完全性心脏传导阻滞患者的影响。
双盲交叉比较，每种起搏模式持续一个月。
10例年龄在23 - 74岁之间的连续患者，静息和运动时均表现为完全性房室传导阻滞，且心房率反应正常，接受了Synergyst I（美敦力）起搏器。
症状评分、跑步机上的最大运动表现以及心房利钠肽、肾上腺素和去甲肾上腺素的血浆浓度。
在呼吸困难、疲劳和情绪障碍的症状评分、运动时间以及最大耗氧量方面，两种起搏模式之间未发现显著差异。1例心室心房传导正常的患者在VVIR起搏期间发生了起搏器综合征。完全性心脏传导阻滞患者静息时心房利钠肽的血浆浓度升高，DDD起搏可使其恢复正常，但VVIR起搏不能。完全性心脏传导阻滞患者以及两种起搏模式下静息时血浆儿茶酚胺浓度均正常。运动期间，两种起搏模式下所有三种激素浓度的升高相似。
在完全性房室传导阻滞患者中，DDD起搏期间的症状和最大运动表现并不比VVIR起搏期间更好。
