Pakarinen Sami, Toivonen Lauri
Department of Cardiology, Meilahti Hospital, Helsinki University Central Hospital, Haartmaninkatu 4, P.O. Box 340, 00029 HUS, Helsinki, Finland.
J Interv Card Electrophysiol. 2012 Nov;35(2):207-13. doi: 10.1007/s10840-012-9691-4. Epub 2012 Jun 12.
The aim of the study was to evaluate the performance of pacemakers (PM) atrial tachyarrhythmia (AT)-sensing algorithms in sinus node dysfunction (SND) patients with DDDR pacing programmed with a fixed long atrioventricular (AV) delay.
In a prospective study, a total of 60 patients with SND were implanted with a dual-chamber PM with two different algorithms for detection of ATs. The study was done with a 3 month data collection period retrieved from the memory of PM and with a 7 day external Holter recording period.
In 13 of 16 (81 %) patients whose Holter recording revealed the presence of ATs, episodes of AT sensing were retrieved from the PM memory with electrograms verifications, confirming that the devices had detected the ATs. Very short ATs seen in Holter recordings were missed by the PM with three patients. However, with all these patients after 3 months of follow up period, there were recognized periods of ATs by the PM. With ten (17 %) patients, there were intermittent periods of undersensing by the PM although continuous atrial fibrillation (AF) was seen in the Holter recording. Retrograde conduction caused false AT detection due to repetitive non-reentrant ventriculoatrial synchronous rhythm (RNRVAS) in six (25 %) of the 24 patients with retrograde conduction.
Even with long AV delay, ATs can be accurately identified. However, transient undersensing of continuous AF and non-detection of very short AT episodes can still occur. Programming a long AV delay predisposes to RNRVAS which can cause false AT detection and symptoms in SND patients who have retrograde conduction.
本研究旨在评估起搏器（PM）心房快速性心律失常（AT）感知算法在窦房结功能障碍（SND）患者中的性能，这些患者采用固定长房室（AV）延迟进行DDDR起搏编程。
在一项前瞻性研究中，共有60例SND患者植入了具有两种不同AT检测算法的双腔PM。该研究通过从PM存储器中检索3个月的数据收集期以及7天的外部动态心电图记录期来完成。
在动态心电图记录显示存在AT的16例患者中的13例（81%）中，通过心电图验证从PM存储器中检索到了AT感知事件，证实设备检测到了AT。有3例患者的动态心电图记录中出现的极短AT未被PM检测到。然而，在所有这些患者经过3个月的随访期后，PM识别出了AT期。有10例（17%）患者，尽管动态心电图记录中可见持续性心房颤动（AF），但PM存在间歇性感知不足。在24例有逆行传导的患者中的6例（25%）中，逆行传导由于重复性非折返性室房同步节律（RNRVAS）导致了错误的AT检测。
即使AV延迟较长，也能准确识别AT。然而，持续性AF的短暂感知不足和极短AT发作的未检测仍可能发生。设置较长的AV延迟易引发RNRVAS，这可能导致有逆行传导的SND患者出现错误的AT检测和症状。
