Occhetta E, Magnani A, Prando M D, Perucca A, Rossi L, Rognoni G, Rossi P
G Ital Cardiol. 1986 Nov;16(11):909-21.
Dual chamber pacemakers, with coordinate atrial and ventricular sensing and stimulation (DDD), even if allowing "physiological" pacing, exhibited new and complicated arrhythmic manifestations, whose real frequency is still unascertained. In 65 patients (mean age 68 +/- 12 years), implanted with a DDD multiprogrammable device (15 pts. Medtronic Versatrax 7000 A, 50 pts. Pacesetter AFP 283), we carried out a 24 hours Holter monitoring while pacemaker was programmed with standard parameters. In a subset of 15 patients Holter monitoring was performed before and after pacemaker implantation. We evidenced: a) atrial sensing and/or pacing malfunction in 3 patients (4.5%); b) pacer-unrelated arrhythmias in 49 patients (75%): atrial extra beats 35 patients (54%), ventricular extra beats 23 patients (35%), non-sustained ventricular tachycardias 10 patients (15%), atrial tachyarrhythmias 8 patients (12%); c) supraventricular arrhythmias with PM-mediated high rate ventricular pacing in 12 patients (18%); d) PM induced and sustained endless loop tachycardias in 31 patients (47%); e) arrhythmias depending on over-sensing in 11 patients (17%): myopotential interferences 9 patients (14%), cross-talk ventricular pacing inhibition 2 patients (3%). The prevalence of ventricular arrhythmias was not different before and after the pacemaker implantation. The prevalence of atrial extrasystoles (53% versus 40%) and atrial tachyarrhythmias (26% versus 6%) decreased after the pacemaker implantation. Aimed reprogramming with progressive extension of atrial refractory period (from 250 to 400 msec and DDX) achieved disappearance of PM-endless loop tachycardias in 95%. Use of multi-programmability lowered the incidence and symptoms of most PM-related arrhythmias. Drug therapy was of choice in clinical arrhythmias unrelated to pacer.
双腔起搏器，具有协调的心房和心室感知及刺激功能（DDD），即使能实现“生理性”起搏，也会出现新的、复杂的心律失常表现，其实际发生率仍不确定。在65例患者（平均年龄68±12岁）中，植入了DDD多程控装置（15例为美敦力Versatrax 7000 A，50例为百盛AFP 283），在起搏器按标准参数程控时进行了24小时动态心电图监测。在15例患者的亚组中，在起搏器植入前后均进行了动态心电图监测。我们发现：a）3例患者（4.5%）存在心房感知和/或起搏功能障碍；b）49例患者（75%）存在与起搏器无关的心律失常：房性早搏35例（54%），室性早搏23例（35%），非持续性室性心动过速10例（15%），房性快速心律失常8例（12%）；c）12例患者（18%）出现伴有起搏器介导的高频率心室起搏的室上性心律失常；d）31例患者（47%）出现起搏器诱发并持续的无休止环行性心动过速；e）11例患者（17%）出现与过度感知有关的心律失常：肌电位干扰9例（14%），串扰性心室起搏抑制2例（3%）。起搏器植入前后室性心律失常的发生率无差异。起搏器植入后房性早搏（53%对40%）和房性快速心律失常（26%对6%）的发生率下降。通过逐步延长心房不应期（从250毫秒延长至400毫秒并采用DDX）进行目标性程控，95%的起搏器介导的无休止环行性心动过速消失。多程控功能的使用降低了大多数与起搏器相关的心律失常的发生率和症状。对于与起搏器无关的临床心律失常，药物治疗是首选。
