Nitardy Aischa, Langreck Holger, Dietz Rainer, Stockburger Martin
Dept. of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
Clin Res Cardiol. 2009 Jan;98(1):25-32. doi: 10.1007/s00392-008-0716-z. Epub 2008 Oct 13.
Right ventricular (RV) pacing increases the incidence of atrial fibrillation (AF) and hospitalization rate for heart failure. Many patients with sinus node dysfunction (SND) are implanted with a DDDR pacemaker to ensure the treatment of slowly conducted atrial fibrillation and atrioventricular (AV) block. Many pacemakers are never reprogrammed after implantation. This study aims to evaluate the effectiveness of programming DDIR with a long AV delay in patients with SND and preserved AV conduction as a possible strategy to reduce RV pacing in comparison with a nominal DDDR setting including an AV search hysteresis.
In 61 patients (70 +/- 10 years, 34 male, PR < 200 ms, AV-Wenckebach rate at > or =130 bpm) with symptomatic SND a DDDR pacemaker was implanted. The cumulative prevalence of right ventricular pacing was assessed according to the pacemaker counter in the nominal DDDR-Mode (AV delay 150/120 ms after atrial pacing/sensing, AV search hysteresis active) during the first postoperative days and in DDIR with an individually programmed long fixed AV delay after 100 days (median).
With the nominal DDDR mode the median incidence of right ventricular pacing amounted to 25.2%, whereas with DDIR and long AV delay the median prevalence of RV pacing was significantly reduced to 1.1% (P < 0.001). In 30 patients (49%) right ventricular pacing was almost completely (<1%) eliminated, n = 22 (36%) had >1% <20% and n = 4 (7%) had >40% right ventricular pacing. The median PR interval was 161 ms. The median AV interval with DDIR was 280 ms.
The incidence of right ventricular pacing in patients with SND and preserved AV conduction, who are treated with a dual chamber pacemaker, can significantly be reduced by programming DDIR with a long, individually adapted AV delay when compared with a nominal DDDR setting, but nonetheless in some patients this strategy produces a high proportion of disadvantageous RV pacing. The DDIR mode with long AV delay provides an effective strategy to reduce unnecessary right ventricular pacing but the effect has to be verified in every single patient.
右心室（RV）起搏会增加心房颤动（AF）的发生率和心力衰竭的住院率。许多窦房结功能障碍（SND）患者植入了双腔双感知频率应答式（DDDR）起搏器，以确保对缓慢传导的心房颤动和房室（AV）传导阻滞进行治疗。许多起搏器植入后从未重新编程。本研究旨在评估对SND且房室传导功能保留的患者设置长房室延迟的DDIR模式的有效性，作为一种与包括房室搜索滞后功能的标称DDDR设置相比减少右心室起搏的可能策略。
对61例有症状的SND患者（年龄70±10岁，男性34例，PR<200毫秒，≥130次/分时房室文氏率）植入DDDR起搏器。根据起搏器计数器评估术后最初几天标称DDDR模式（心房起搏/感知后房室延迟150/120毫秒，房室搜索滞后功能开启）以及100天（中位数）后设置个体化长固定房室延迟的DDIR模式下右心室起搏的累积发生率。
在标称DDDR模式下，右心室起搏的中位发生率为25.2%，而在DDIR模式且设置长房室延迟时，右心室起搏的中位发生率显著降至1.1%（P<0.001）。30例患者（49%）的右心室起搏几乎完全（<1%）消除，22例患者（36%）右心室起搏>1%且<20%，4例患者（7%）右心室起搏>40%。PR间期的中位数为161毫秒。DDIR模式下房室间期的中位数为280毫秒。
与标称DDDR设置相比，对植入双腔起搏器治疗的SND且房室传导功能保留的患者设置长的个体化房室延迟的DDIR模式，可显著降低右心室起搏的发生率，但在一些患者中，该策略仍会产生较高比例的不利右心室起搏。设置长房室延迟的DDIR模式是减少不必要右心室起搏的有效策略，但必须在每个患者中进行验证。
