Department of Cardiology, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
Europace. 2013 Dec;15(12):1757-62. doi: 10.1093/europace/eut213. Epub 2013 Jul 12.
To determine whether atrial-based pacing prevents atrial arrhythmias in adults with congenital heart disease (CHD) compared with ventricular pacing.
All adult CHD patients from four participating centres with a permanent pacemaker were identified. Patients with permanent atrial arrhythmias at pacemaker implantation and patients who received a pacemaker for treatment of drug-refractory atrial arrhythmias were excluded. The final study population consisted of 211 patients (52% male, 36% complex CHD) who received a first pacemaker for sick sinus dysfunction (n = 82) or atrioventricular block (n = 129) at a median age of 24 years [interquartile range (IQR), 12-34]. A history of atrial arrhythmias at implantation was present in 49 patients (23%). Atrial-based pacing was the initial pacing mode in 139 patients (66%) while the others (34%) received ventricular pacing. During a median follow-up of 13 years (IQR, 7-21), 90 patients (43%) developed an atrial arrhythmia. Multivariate analysis demonstrated no significant effect of atrial-based pacing on subsequent atrial arrhythmias [hazard ratio (HR), 1.53; 95% confidence interval (CI), 0.91-2.56; P = 0.1]. Independent predictors of atrial arrhythmia were history of atrial arrhythmias (HR, 5.55; 95% CI, 3.47-8.89; P< 0.0001), older age (≥18 years) at pacemaker implantation (HR, 2.29; 95% CI, 1.29-4.04; P = 0.005), and complex CHD (HR, 1.57; 95% CI, 1.01-2.45; P = 0.04).
In contrast to the general population, atrial-based pacing was not associated with a lower incidence of atrial arrhythmia in adults with CHD.
确定与心室起搏相比，基于心房的起搏是否可预防先天性心脏病（CHD）成人的心房性心律失常。
在四个参与中心确定了所有患有永久性起搏器的成年 CHD 患者。排除了在起搏器植入时患有永久性心房性心律失常以及因药物难治性心房性心律失常而接受起搏器治疗的患者。最终的研究人群由 211 名患者组成（52%为男性，36%为复杂 CHD），他们因病态窦房结功能障碍（n=82）或房室传导阻滞（n=129）而首次植入起搏器，中位年龄为 24 岁[四分位距（IQR），12-34]。49 名患者（23%）在植入时存在心房性心律失常史。139 名患者（66%）最初采用基于心房的起搏模式，而其他 34%的患者采用心室起搏模式。在中位随访 13 年（IQR，7-21）期间，90 名患者（43%）发生了心房性心律失常。多变量分析显示，基于心房的起搏对随后发生的心房性心律失常无显著影响[风险比（HR），1.53；95%置信区间（CI），0.91-2.56；P=0.1]。心房性心律失常的独立预测因素为心房性心律失常史（HR，5.55；95%CI，3.47-8.89；P<0.0001）、起搏器植入时年龄较大（≥18 岁）（HR，2.29；95%CI，1.29-4.04；P=0.005）和复杂 CHD（HR，1.57；95%CI，1.01-2.45；P=0.04）。
与一般人群相比，在 CHD 成人中，基于心房的起搏与较低的心房性心律失常发生率无关。
