Jordaens L, de Backer G, Clement D L
Department of Cardiology, Akademisch Ziekenhuis, State University Ghent, Belgium.
Jpn Heart J. 1988 Jan;29(1):35-44. doi: 10.1536/ihj.29.35.
It is not clear whether hemodynamic and other benefits from dual-chamber pacing also exist in elderly patients. We studied a group of 18 elderly patients (mean age 74 +/- 4 yrs) with exercise testing in DDD and VVI modes in a randomized way to compare the effects of these pacing modes on exercise capacity, atrial rate and exercise-induced arrhythmias. Patients were selected when complete heart block was present without clinical evidence of sinus node dysfunction. Significant differences were observed: atrial rate was lower during exercise in DDD-mode (p less than 0.01); exercise time and cumulative load increased (p less than 0.05); maximal oxygen uptake was improved (p less than 0.05). Some of these differences were less clear in a subgroup with replacement of a VVI-device by DDD-stimulation. No differences could be observed in severity of exercise-induced arrhythmias. No evidence of sinus node dysfunction was found during exercise. Reprogramming of atrial sensitivity was required in 3 patients, with reprogramming to DVI because of paroxysmal atrial fibrillation once. Two patients died within a mean follow-up period of 13 months. Sinus rhythm was present at the most recent evaluation in all patients, including the patient stimulated in the DVI mode. Physiologic stimulation is of value for elderly patients with an active life style and complete heart block. Reprogramming to another pacing mode is only seldom necessary.
双腔起搏带来的血流动力学及其他益处是否也存在于老年患者中尚不清楚。我们对一组18例老年患者（平均年龄74±4岁）进行了研究，通过随机方式在DDD和VVI模式下进行运动测试，以比较这些起搏模式对运动能力、心房率及运动诱发心律失常的影响。入选患者为存在完全性心脏传导阻滞且无窦房结功能障碍临床证据者。观察到显著差异：DDD模式下运动时心房率较低（p<0.01）；运动时间和累积负荷增加（p<0.05）；最大摄氧量改善（p<0.05）。在将VVI装置更换为DDD刺激的亚组中，其中一些差异不太明显。运动诱发心律失常的严重程度未观察到差异。运动期间未发现窦房结功能障碍的证据。3例患者需要重新调整心房敏感性，其中1例因阵发性心房颤动曾重新调整为DVI模式。2例患者在平均13个月的随访期内死亡。在包括以DVI模式刺激的患者在内的所有患者的最近一次评估中均存在窦性心律。生理性刺激对具有积极生活方式和完全性心脏传导阻滞的老年患者具有价值。很少需要重新调整为另一种起搏模式。
