Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Department of Medicine, Faculty of Health Science, University of Cape Town, South Africa. Email:
Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Cardiovasc J Afr. 2021;32(1):17-20. doi: 10.5830/CVJA-2020-040. Epub 2020 Sep 18.
The aim of the study was to compare the clinical outcomes [atrial fibrillation (AF), atrio-ventricular (AV) block, device sepsis and lead revision] of patients with sinus node dysfunction (SND) between atrial-pacing atrial-sensing inhibited-response rate-adaptive (AAIR) versus dual-chamber rate-adaptive (DDDR) pacing. The choice of AAIR pacing versus DDDR pacing was determined by AV nodal functional testing at implant.
We conducted a retrospective review of consecutive patients who underwent AAIR and DDDR pacing over a 10-year period.
One hundred and sixteen patients required pacing for symptomatic SND. Fifty-four (46.6%) patients received AAIR pacemakers and 62 (53.4%) received DDDR pacemakers based on AV nodal functional testing at implant. Patients who had AV Wenkebach with atrial pacing at 120 beats per minute received DDDR pacing. Overall the mean age of patients with SND was 65 years and 66.4% were females, 30% were diabetics and 71% were hypertensives. Pre-syncope/syncope (84%) and dizziness (69%) were the most common symptoms. Sinus pauses and sinus bradycardia were the most common ECG manifestations. Over a median follow up of five (IQR: 2-11) years, four patients (7.4%) developed AF in the AAIR group compared to three (4.8%) in the DDDR group ( = 0.70). AV block occurred in one patient in the AAIR group, who required an upgrade to a DDDR pacemaker. There was no difference in device sepsis or need for lead revision between the two groups.
We found that AV nodal functional testing with atrial pacing at the time of pacemaker implantation was a useful tool to help guide the implanter between AAIR or DDDR pacing. Patients who underwent AAIR pacing had a low risk of AF, AV block or lead revision. In resource-limited settings, AAIR pacing guided by AV nodal functional testing should be considered as an alternative to DDDR pacing.
本研究旨在比较窦房结功能障碍（SND）患者的临床结果[心房颤动（AF）、房室（AV）阻滞、器械感染和导联修正]，比较采用心房起搏、感知抑制、反应率适应性（AAIR）与双腔率适应性（DDDR）起搏的患者。AAIR 起搏与 DDDR 起搏的选择取决于植入时 AV 结功能测试。
我们对 10 年来接受 AAIR 和 DDDR 起搏的连续患者进行了回顾性分析。
116 例因症状性 SND 需起搏的患者。54 例（46.6%）患者根据植入时 AV 结功能测试植入 AAIR 起搏器，62 例（53.4%）植入 DDDR 起搏器。心房起搏 120 次/分时 AV Wenkebach 的患者植入 DDDR 起搏器。SND 患者的平均年龄为 65 岁，女性占 66.4%，30%为糖尿病患者，71%为高血压患者。最常见的症状是预晕厥/晕厥（84%）和头晕（69%）。最常见的心电图表现是窦房结暂停和窦性心动过缓。中位随访 5 年（IQR：2-11），AAIR 组有 4 例（7.4%）发生 AF，DDDR 组有 3 例（4.8%）（ = 0.70）。AAIR 组有 1 例发生 AV 阻滞，需升级为 DDDR 起搏器。两组之间在器械感染或导联修正方面无差异。
我们发现，在植入起搏器时进行心房起搏的 AV 结功能测试是一种有用的工具，可以帮助指导植入者选择 AAIR 或 DDDR 起搏。接受 AAIR 起搏的患者发生 AF、AV 阻滞或导联修正的风险较低。在资源有限的情况下，应考虑根据 AV 结功能测试指导的 AAIR 起搏作为 DDDR 起搏的替代方案。
