Luo Z M
Chang Zheng Hospital, Second Military Medical College, PLA, Shanghai.
Zhonghua Xin Xue Guan Bing Za Zhi. 1990 Oct;18(5):276-8, 319.
Unipolar demand pacemaker myopotential inhibition by 5 different provocative maneuvers was studied in 48 patients with stable pacing rhythm out of 82 patients with unipolar pacemakers from 3 manufacturers implanted over the right pectoralis major to evaluate the incidence of inhibiting phenomenon and its clinical significance. Transient pacing inhibition occurred in 19 (39.6%) of the 48 patients. Among them 3 (30.0%) of 10 patients with Model 28 (EDWARDS), 6 (31.6%) of 19 patients with Model 30 (EDWARDS), 10 (71.4%) of 14 patients with Model 7550 (ELAMEDICAL), and none of the 5 patients with Model P101 (QINMING). The effective maneuvers were the right hand-to-left shoulder press (63.2% positivity), the uprising from a supine position (21.0% positivity) and the hand-to-hand press (15.8% positivity). No pacemaker myopotential inhibition had been induced by Valsalva maneuver and the left hand-to-right shoulder press. 19 patients with positive myopotential inhibition had pauses of pacemaker function lasting from 1.2 to 3.9 seconds, 13 of them with pauses more than 2 seconds. Of all 48 patients, 9 (18.7%) experienced symptoms of cerebral ischemia due to pacemaker myopotential inhibition during test, among whom 8 had ventricular standstill more than 2 seconds. This showed a close relation between symptoms and duration of the pacing inhibition. The causes of the phenomenon and its prevention were briefly discussed.
在82例植入了3个厂家生产的单极起搏器（经右胸大肌植入）的患者中，选取48例起搏节律稳定的患者，研究5种不同激发动作对单极按需起搏器肌电位的抑制作用，以评估抑制现象的发生率及其临床意义。48例患者中有19例（39.6%）出现短暂起搏抑制。其中，28型（爱德华兹公司）的10例患者中有3例（30.0%），30型（爱德华兹公司）的19例患者中有6例（31.6%），7550型（伊拉医疗公司）的14例患者中有10例（71.4%），而P101型（秦明公司）的5例患者中无一例出现。有效的激发动作是右手按压左肩（阳性率63.2%）、从仰卧位起身（阳性率21.0%）和双手互压（阳性率15.8%）。瓦尔萨尔瓦动作和左手按压右肩未诱发起搏器肌电位抑制。19例肌电位抑制阳性的患者起搏器功能暂停持续1.2至3.9秒，其中13例暂停超过2秒。在所有48例患者中，9例（18.7%）在测试期间因起搏器肌电位抑制出现脑缺血症状，其中8例心室停搏超过2秒。这表明症状与起搏抑制持续时间密切相关。文中简要讨论了该现象的原因及其预防措施。
