Langenfeld H, Grimm W, Maisch B, Kochsiek K
University Hospital of Internal Medicine, Würzburg, FRG.
Pacing Clin Electrophysiol. 1988 Dec;11(12):2198-206. doi: 10.1111/j.1540-8159.1988.tb05986.x.
We investigated the course of symptoms and the spontaneous ECG retrospectively in 308 patients who had received a pacemaker because of atrioventricular (AV) block (n = 115), sick sinus syndrome (SSS, n = 107), bradyarrhythmic atrial fibrillation (bradyarrhythmia, n = 51), carotid sinus syndrome (CSS, n = 16), complete bifascicular block associated with 1st degree AV block (n = 13) and with other indications (n = 6). The mean implantation time was 63 months. The clinical state of 93% of all patients improved after pacemaker implantation; their symptoms decreased markedly. Persisting syncopy in some patients with SSS, however, supports a restricted implantation policy. We rarely saw improved AV conduction in patients with AV block (11%). Furthermore, in patients with SSS, atrial fibrillation occurred significantly more often (35%) than in those with AV block (17%; P less than 0.01). Only 3% of patients with SSS developed 2nd and 3rd degree AV block within the observation period. In all patients with initial bifascicular block and additional 1st degree AV block, pacing prevented further syncopal attacks; four of them showed 3rd degree AV block at control, indicating that pacemaker implantation is mandatory in symptomatic patients with bifascicular disease and 1st degree AV block.
我们回顾性研究了308例因房室传导阻滞（n = 115）、病态窦房结综合征（SSS，n = 107）、缓慢性心律失常型心房颤动（缓慢性心律失常，n = 51）、颈动脉窦综合征（CSS，n = 16）、伴有一度房室传导阻滞的完全性双分支阻滞（n = 13）以及其他适应证（n = 6）而接受起搏器植入的患者的症状演变过程和自发性心电图。平均植入时间为63个月。所有患者中93%在起搏器植入后临床状态改善，症状明显减轻。然而，一些病态窦房结综合征患者持续存在晕厥，这支持了有限的植入策略。我们很少看到房室传导阻滞患者的房室传导得到改善（11%）。此外，病态窦房结综合征患者发生心房颤动的频率显著高于房室传导阻滞患者（35%比17%；P<0.01）。在观察期内，只有3%的病态窦房结综合征患者发生了二度和三度房室传导阻滞。在所有最初有双分支阻滞并伴有一度房室传导阻滞的患者中，起搏预防了进一步的晕厥发作；其中4例在复查时出现了三度房室传导阻滞，这表明对于有症状的双分支疾病合并一度房室传导阻滞患者，起搏器植入是必要的。
