Kimura Yuki, Sumiyoshi Masataka, Inoue Kenji, Shiozaki Masayuki, Fukuda Kentaro, Fujiwara Yasumasa, Tabuchi Haruna, Hayashi Hidemori, Sekita Gaku, Tokano Takashi, Nakazato Yuji, Daida Hiroyuki
Department of Cardiology Juntendo University Nerima Hospital Tokyo Japan.
Department of Cardiology Juntendo University School of Medicine Tokyo Japan.
J Arrhythm. 2018 May 28;34(4):450-454. doi: 10.1002/joa3.12072. eCollection 2018 Aug.
In pacemaker-dependent patients, the risk of asystole must be managed during device replacement. This study aimed to examine whether we could predict the indication for temporary pacing (TP) during the generator replacement.
We studied 105 consecutive patients who underwent pacemaker replacement due to battery depletion at Juntendo Nerima Hospital between September 2005 and December 2016. We examined the relationship between the stability of the intrinsic rhythm (IR) during pacemaker replacement and several clinical factors including age, gender, sick sinus syndrome or atrioventricular (AV) block, duration of pacing, structural heart disease, use of anti-arrhythmic drugs, and the presence/absence of a stable IR (>40 bpm) at the outpatient clinic (OPC) just before pacemaker replacement.
Of the 105 patients, we excluded 1 patient who required TP because of bradycardia-dependent torsades de points. Therefore, we evaluated 104 patients for the indication for TP. TP was underwent in 19 patients (18%) because of an absence or instability of the IR during pacemaker replacement. The indication for TP was significantly correlated with AV block (84% vs 48%, = .0044) and the absence of a stable IR at the last OPC visit (89% vs 24%, < .0001). For predicting the indication for TP, the following values of no stable IR at the last OPC visit were obtained: 89% sensitivity, 77% specificity, 46% positive predictive value, and 97% negative predictive value.
The presence of a stable IR at the last OPC visit was a good predictor (97%) of no indication for TP during pacemaker replacement.
在起搏器依赖患者中，更换设备期间必须应对心脏停搏风险。本研究旨在探讨我们是否能够预测发生器更换期间临时起搏（TP）的指征。
我们研究了2005年9月至2016年12月间在顺天堂练马医院因电池耗尽而接受起搏器更换的105例连续患者。我们研究了起搏器更换期间固有心律（IR）的稳定性与包括年龄、性别、病态窦房结综合征或房室（AV）阻滞、起搏持续时间、结构性心脏病、抗心律失常药物的使用以及起搏器更换前门诊（OPC）时稳定IR（>40次/分）的有无等几个临床因素之间的关系。
105例患者中，我们排除了1例因心动过缓依赖性尖端扭转型室速而需要TP的患者。因此，我们评估了104例患者的TP指征。19例患者（18%）因起搏器更换期间IR缺失或不稳定而接受了TP。TP指征与AV阻滞（84%对48%，P = .0044）以及上次OPC就诊时无稳定IR（89%对24%，P < .0001）显著相关。为预测TP指征，获得了上次OPC就诊时无稳定IR的以下数值：灵敏度89%、特异度77%、阳性预测值46%和阴性预测值97%。
上次OPC就诊时存在稳定IR是起搏器更换期间无TP指征的良好预测指标（97%）。
