Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine.
Int Heart J. 2021 Mar 30;62(2):344-349. doi: 10.1536/ihj.20-363. Epub 2021 Mar 17.
Cardiovascular event rates of patients with a dipper blood pressure (BP) and dipper heart rate (HR) pattern are lower than those of patients with nondipper BP and HR patterns. However, how the pacemaker mode affects the diurnal BP and HR patterns remains unclear.We enrolled nine patients (average age 74.4 ± 6.6 years, 4 males and 5 females) with sick sinus syndrome who required atrial pacing. We investigated sequential 6-month pacing regimens (DDD mode at 60 bpm and sleep rate mode). We set the lower rate of sleep rate mode as follows: 60 bpm during the daytime and 50 bpm during the nighttime. The order of pacing mode was randomized, with crossover design. Ambulatory BP monitoring was performed at baseline, 6 months, and 12 months, BP category was classified into four groups (extreme dipper, dipper, nondipper, and riser pattern), and HR was classified into dipper and nondipper patterns.Nighttime HR during the sleep rate mode was significantly lower than that at DDD (57.1 ± 6.2 versus 63.5 ± 3.8 bpm, P = 0.001). The dipper HR pattern was increased in the sleep rate mode compared with those at baseline or DDD mode (versus baseline: 89% versus 44%, P = 0.035; versus DDD: 89% versus 22%, P = 0.004). The dipper BP pattern significantly increased in the sleep rate mode compared with the baseline (56% versus 11%, P = 0.035), but the difference between the sleep rate mode and DDD mode was statistically marginal (56% versus 22%, P = 0.081).The pacemaker settings in the sleep rate mode increased the dipper HR and BP patterns in pacemaker-dependent patients with sick sinus syndrome.
血压和心率呈杓型模式的患者心血管事件发生率低于非杓型模式的患者。然而，起搏器模式如何影响日间血压和心率模式尚不清楚。我们纳入了 9 名（平均年龄 74.4±6.6 岁，男 4 例，女 5 例）需要进行心房起搏的病态窦房结综合征患者。我们研究了连续 6 个月的起搏方案（60 次/分的双腔起搏和睡眠频率模式）。我们将睡眠频率模式的下限率设置为：白天 60 次/分，夜间 50 次/分。起搏模式的顺序是随机的，采用交叉设计。在基线、6 个月和 12 个月时进行动态血压监测，将血压类别分为四组（极度杓型、杓型、非杓型和升型），并将心率分为杓型和非杓型。睡眠频率模式下的夜间心率明显低于 DDD（57.1±6.2 次/分比 63.5±3.8 次/分，P=0.001）。与基线或 DDD 相比，睡眠频率模式下的杓型心率增加（与基线相比：89%比 44%，P=0.035；与 DDD 相比：89%比 22%，P=0.004）。与基线相比，睡眠频率模式下的杓型血压模式显著增加（56%比 11%，P=0.035），但睡眠频率模式与 DDD 模式之间的差异无统计学意义（56%比 22%，P=0.081）。睡眠频率模式下的起搏器设置增加了依赖起搏器的病态窦房结综合征患者的杓型心率和血压模式。
