Langenfeld H, Grimm W, Maisch B, Kochsiek K
University Hospital of Internal Medicine, Wurzburg, FRG.
Pacing Clin Electrophysiol. 1988 Nov;11(11 Pt 2):1667-72. doi: 10.1111/j.1540-8159.1988.tb06292.x.
Atrial fibrillation (AF) and thromboembolism are discussed to be complications of the VVI mode. We reinvestigated the spontaneous ECG and the anamnesis of 246 pacemaker patients with the indications second and third degree atrioventricular block (AV block, n = lll), sick sinus syndrome (SSS, n = 101) and other indications (n = 34), all had shown sinus rhythm at implantation. The mean implantation time was 63 +/- 45 months (203 VVI and 43 dual chamber pacemakers).
(1) Atrial fibrillation was found in 63 patients (26%). Only one of them had a DDD pacemaker inserted, the implantation time of dual chamber devices being shorter, however, (2) The incidence of AF in patients with SSS (37%) was significantly higher (P less than 0.01) than in patients with AV block (19%). (3) Three patients suffered from strokes or transitory ischemic attacks in the follow-up, only one of them had AF at control.
Our results confirm that VVI stimulation favors AF long-term which is most likely due to irritation of the atrial rhythm by retrograde conduction. In our patients the incidence of thromboembolic complications was not higher in the group of patients with AF. However, from this study in surviving patients, we cannot exclude that we lost some patients due to severe stroke.
心房颤动（AF）和血栓栓塞被认为是VVI模式的并发症。我们重新研究了246例起搏器植入患者的自发心电图和病史，这些患者的适应证为二度和三度房室传导阻滞（AV阻滞，n = 111）、病态窦房结综合征（SSS，n = 101）以及其他适应证（n = 34），所有患者在植入时均表现为窦性心律。平均植入时间为63±45个月（203台VVI起搏器和43台双腔起搏器）。
（1）63例患者（26%）发生心房颤动。其中只有1例植入了DDD起搏器，双腔起搏器的植入时间较短，然而，（2）SSS患者中AF的发生率（37%）显著高于AV阻滞患者（19%）（P<0.01）。（3）随访中有3例患者发生中风或短暂性脑缺血发作，其中仅1例在检查时有AF。
我们的结果证实VVI刺激长期有利于AF的发生，这很可能是由于逆行传导刺激心房节律所致。在我们的患者中，AF患者组血栓栓塞并发症的发生率并不更高。然而，从这项对存活患者的研究中，我们不能排除因严重中风而失去一些患者的可能性。
