Janosik D L, Redd R M, Buckingham T A, Blum R I, Wiens R D, Kennedy H L
Department of Internal Medicine, St. Louis University Medical Center, Missouri.
Am J Cardiol. 1987 Nov 1;60(13):1030-5. doi: 10.1016/0002-9149(87)90347-x.
The value of ambulatory electrocardiography (AECG) in detecting pacemaker dysfunction before hospital discharge was assessed in 100 patients a mean of 1.2 days after pacemaker implantation. The incidence of permanent pacemaker dysfunction detected by AECG in the early postimplantation period, the frequency that pacemaker dysfunction detected by AECG was not detected by telemetric monitoring and the frequency that results of AECG led to pacemaker reprogramming before hospital discharge were determined. AECG detected at least 1 type of pacemaker dysfunction in 35% of patients and routine telemetry identified the abnormality in only 8% (p less than 0.001). Pacemaker dysfunction occurred in 42% of patients with dual-chamber devices and 27% of those with single-chamber devices (difference not significant). In the 35 patients who had pacemaker malfunction, a total of 50 instances of pacemaker dysfunction were detected. Failure of atrial capture occurred in 2% of patients, failure of atrial sensing in 9%, failure of atrial output in 1%, failure of ventricular capture in 8%, failure of ventricular sensing in 14%, failure of ventricular output due to myopotential inhibition in 11% and pacemaker-mediated tachycardia in 5%. The results of the AECG led to a clinical intervention in 22 patients (pacemaker reprogramming in 21 patients and lead repositioning in 1 patient) in whom no pacemaker dysfunction was suspected on the basis of telemetry or clinical symptoms. In conclusion, AECG provides additional benefit beyond that of routine telemetry monitoring in identifying pacemaker dysfunction in the early period after implantation.
对100例患者在起搏器植入后平均1.2天进行动态心电图（AECG）检查，以评估其在出院前检测起搏器功能障碍的价值。确定了植入后早期通过AECG检测到的永久性起搏器功能障碍的发生率、通过AECG检测到但遥测监测未发现的起搏器功能障碍的频率以及AECG结果导致出院前起搏器重新编程的频率。AECG在35%的患者中检测到至少1种类型的起搏器功能障碍，而常规遥测仅发现8%的异常（P<0.001）。双腔起搏器患者中42%出现起搏器功能障碍，单腔起搏器患者中27%出现该情况（差异无统计学意义）。在35例出现起搏器故障的患者中，共检测到50例起搏器功能障碍。心房捕捉失败发生在2%的患者中，心房感知失败在9%，心房输出失败在1%，心室捕捉失败在8%，心室感知失败在14%，因肌电位抑制导致的心室输出失败在11%，起搏器介导的心动过速在5%。AECG结果导致22例患者进行临床干预（21例患者进行起搏器重新编程，1例患者进行导线重新定位），这些患者根据遥测或临床症状未怀疑有起搏器功能障碍。总之，在识别植入后早期的起搏器功能障碍方面，AECG比常规遥测监测具有更多优势。
