den Dulk K, Bouwels L, Lindemans F, Rankin I, Brugada P, Wellens H J
Department of Cardiology, Academic Hospital Meastricht, University of Limburg, The Netherlands.
Am J Cardiol. 1988 Jan 1;61(1):107-12. doi: 10.1016/0002-9149(88)91314-8.
Bipolar Medtronic Activitrax rate responsive pacemakers were implanted in 31 patients for ventricular (28) or atrial (3) pacing. Mean follow-up was 16 months (range 10 to 26). Twenty pacemakers were implanted after catheter ablation of the His bundle, 7 for sick sinus syndrome. 1 for atrioventricular block and 3 for sick sinus syndrome with atrioventricular block. A rate response value was selected that gave a pacing rate of about 100 pulses/min during walking. Of the 31 patients, all had 24-hour ambulatory electrocardiographic monitoring with diary, 11 walked a 20-minute circuit, including a flight of stairs, and 20 had a treadmill exercise test. In 9 patients the pacing rate could be compared with the underlying sinus rate during exercise and was seen to match it very closely. In 12 patients the pacing rate during car driving was found to be similar to the sinus rate of 5 volunteers under similar conditions (mean minimum and maximum rate was 80 and 99 pulses/min, respectively). No pacing-induced arrhythmias were seen during ambulatory electrocardiographic monitoring. At high pacing rates slightly irregular pacing intervals were sometimes observed, which was due to polarization sensing. Sporadically, 1 pacing interval shortened to the upper rate value, because of a known and now resolved timing anomaly. Neither anomaly was of clinical consequence and the first could be resolved by reprogramming.(ABSTRACT TRUNCATED AT 250 WORDS)
31例患者植入了美敦力双极Activitrax速率应答起搏器，用于心室起搏（28例）或心房起搏（3例）。平均随访时间为16个月（范围10至26个月）。20例起搏器是在希氏束导管消融术后植入的，7例用于病态窦房结综合征，1例用于房室传导阻滞，3例用于病态窦房结综合征合并房室传导阻滞。选择了一个速率应答值，使步行时的起搏频率约为100次/分钟。31例患者均进行了24小时动态心电图监测并记录日志，11例患者完成了包括一段楼梯的20分钟步行回路，20例患者进行了平板运动试验。9例患者在运动期间可将起搏频率与基础窦性心律进行比较，发现二者非常接近。12例患者在驾驶汽车时的起搏频率与5名志愿者在类似条件下的窦性心律相似（平均最低和最高频率分别为80次/分钟和99次/分钟）。动态心电图监测期间未发现起搏诱发的心律失常。在高起搏频率时，有时会观察到起搏间期略有不规则，这是由于极化感知所致。偶尔，由于已知且现已解决的计时异常，1个起搏间期缩短至上限频率值。这两种异常均无临床后果，第一种异常可通过重新编程解决。（摘要截断于250字）
