右心室起搏比例高是否会影响 1 型肌强直性营养不良患者阵发性心房颤动的发生率？

Does a high percentage of right ventricular pacing influence the incidence of paroxysmal atrial fibrillation in myotonic dystrophy type 1 patients?

出版信息

Kardiol Pol. 2013;71(11):1147-53. doi: 10.5603/KP.2013.0295.

DOI:10.5603/KP.2013.0295

Abstract

BACKGROUND

Paroxysmal atrial tachyarrhythmias occur frequently in myotonic dystrophy type 1 (MD1) patients. Pacemakers, implanted for the treatment of bradyarrhythmias and including detailed diagnostic functions, may facilitate the diagnosis and management of frequent paroxysmal atrial fibrillation (AF) that may remain undetected during a conventional clinical follow-up. The effect of right ventricular pacing on AF incidence is still controversial.

AIM

To evaluate the influence of a high percentage of right ventricular pacing on AF in MD1 patients during a 12-month follow-up period.

METHODS

We enrolled in the present study 70 MD1 patients (age 51.3 ± 5 years; 32 females) who underwent dual chamber pacemaker implantation. At 12 months of follow-up, the study population was divided into three groups according to the percentage of atrial and ventricular stimulation: Group 1, the atrial sensing ventricular sensing group (ASVS; n = 22; age 52 ± 7.7; eight female) with a percentage of atrial and ventricular stimulation lower than 50%; Group 2, the atrial sensing ventricular pacing group (ASVP; n = 24; age 50.5 ± 7.6; 13 female) with a percentage of atrial stimulation lower than 50% and percentage of ventricular stimulation higher than 80%; and Group 3, the atrial pacing ventricular pacing group (APVP; n = 24; age 56 ± 4.3; 11 female) with a percentage of atrial and ventricular stimulation higher than 80%. We counted the number of episodes of atrial arrhythmia that occurred during the observation period and the duration of each episode.

RESULTS

We found a statistically significant difference in the number and duration of AF episodes between the three groups at the 12-month follow-up. In particular, there were more episodes (253 ± 30 vs. 80 ± 27 vs. 53 ± 32; p < 0.03) and longer durations of AF (8,700 ± 630 vs. 4,480 ± 975 vs. 3,853 ± 870 min; p < 0.03) in the ASVP group than in the ASVS group and the APVP group. Lead parameters remained stable over time and there were no displacements of the electrodes after implantation.

CONCLUSIONS

In a 12-month follow-up comparison, we showed a statistically significant increase in paroxysmal AF episodes in MD1 patients with a high percentage of right ventricular pacing and a lower percentage of atrial stimulation.

摘要

背景

肌强直性营养不良 1 型（MD1）患者常发生阵发性房性心动过速。为治疗缓慢性心律失常而植入的起搏器，具有详细的诊断功能，可有助于诊断和管理频繁发生的阵发性心房颤动（AF），而这些在常规临床随访中可能无法检测到。右心室起搏对 AF 发生率的影响仍存在争议。

目的

在 12 个月的随访期间，评估 MD1 患者中右心室起搏比例对 AF 的影响。

方法

我们纳入了 70 名 MD1 患者（年龄 51.3 ± 5 岁；32 名女性），他们接受了双腔起搏器植入。在 12 个月的随访中，根据心房和心室刺激的百分比，将研究人群分为三组：第 1 组为心房感知心室感知组（ASVS；n = 22；年龄 52 ± 7.7；8 名女性），心房和心室刺激百分比均低于 50%；第 2 组为心房感知心室起搏组（ASVP；n = 24；年龄 50.5 ± 7.6；13 名女性），心房刺激百分比低于 50%，心室刺激百分比高于 80%；第 3 组为心房起搏心室起搏组（APVP；n = 24；年龄 56 ± 4.3；11 名女性），心房和心室刺激百分比均高于 80%。我们统计了观察期间发生的房性心律失常发作次数和每次发作的持续时间。

结果

我们发现，在 12 个月的随访中，三组之间的房性心律失常发作次数和持续时间存在统计学显著差异。特别是在 ASVP 组中，房性心律失常发作次数（253 ± 30 次 vs. 80 ± 27 次 vs. 53 ± 32 次；p < 0.03）和持续时间（8,700 ± 630 min vs. 4,480 ± 975 min vs. 3,853 ± 870 min；p < 0.03）均明显长于 ASVS 组和 APVP 组。导线参数在随访期间保持稳定，植入后电极无移位。