Department of Pacing and Clinical Electrophysiology, National Institute of Cardiology, Haller u. 29, Budapest, Hungary.
Europace. 2012 Apr;14(4):481-5. doi: 10.1093/europace/eur308. Epub 2011 Sep 22.
Delivery of a ventricular extrastimulus shortly after the effective refractory period (ERP) of a sensed (coupled pacing; CP) or a paced (paired pacing; PP) ventricular event can instantly decrease the mechanical pulse rate (MPR) during rapidly conducting atrial fibrillation (AF). We compared the short-term rate-controlling effects of CP and PP during AF with rapid ventricular rates.
Sixteen patients with ongoing, spontaneous AF were examined. Mechanical pulse rate was registered via arterial pressure tracings. During CP a coupling interval (CI) of ERP+20 ms was used to reach an optimal haemodynamic effect. Paired pacing was started at a basic cycle length (CL) of 500 ms followed by an extrastimulus with an CI of ERP+20 ms. Drive train was changed at 50 ms increments until the lowest MPR was reached. Proarrhythmic effects were characterized by the number of premature ventricular complexes (PVCs). Mechanical pulse rate significantly decreased in all patients during CP (113 ± 9 vs. 58 ± 4/min). Using CP the controlled rhythm remained irregular (CL range: 896 ± 24-1452 ± 67 ms) while no PVCs were observed. With different drive trains PP resulted in different regular MPRs (range 62 ± 6-80 ± 4/min), but the lowest MPR achieved was significantly higher in the PP group than in the CP. Paired pacing caused premature beats in nine patients (56%) resulting in loss of continuous MPR control.
Both CP and PP can reduce the MPR during rapidly conducting AF. Coupled pacing is more applicable, but PP has the advantage to achieve different target heart rates. Paired pacing has more proarrhythmic effects as compared with CP.
在感知（耦合起搏；CP）或起搏（配对起搏；PP）心室事件的有效不应期（ERP）之后不久给予心室期外刺激，可立即降低快速传导心房颤动（AF）期间的机械脉冲率（MPR）。我们比较了 CP 和 PP 在快速心室率下对 AF 的短期心率控制作用。
检查了 16 例持续自发 AF 的患者。通过动脉压力轨迹记录机械脉冲率。在 CP 期间，使用 ERP+20ms 的耦合间隔（CI）达到最佳血液动力学效果。配对起搏从基本周期长度（CL）为 500ms 开始，然后给予 ERP+20ms 的期外刺激。驱动列车以 50ms 的增量进行更改，直到达到最低 MPR。通过过早的室性期前收缩（PVCs）的数量来描述致心律失常作用。在所有患者中，CP 期间机械脉冲率均显著降低（113±9 与 58±4/min）。使用 CP 时，控制节律仍不规则（CL 范围：896±24-1452±67ms），而未观察到 PVCs。使用不同的驱动列车，PP 导致不同的规则 MPR（范围 62±6-80±4/min），但在 PP 组中达到的最低 MPR 明显高于 CP 组。配对起搏导致 9 例患者（56%）出现过早搏动，导致连续 MPR 控制丧失。
CP 和 PP 均可降低快速传导 AF 期间的 MPR。耦合起搏更适用，但 PP 具有实现不同目标心率的优势。与 CP 相比，配对起搏具有更多的致心律失常作用。
