Gialafos J, Maillis A, Kandilas J
Department of Cardiology, University of Athens Medical School, Greece.
Eur Heart J. 1987 Aug;8 Suppl D:149-54. doi: 10.1093/eurheartj/8.suppl_d.149.
The standard exercise tests are usually inadequate for revealing the nature of oversensing problems associated with skeletal muscle myopotentials. We used special exercises, designed to test the rectus abdominis (RA) and pectoralis major (PM) muscle groups specifically, in a study of a large number of paced patients. We examined a total of 252 paced patients, with or without symptoms and in steady pacing rhythm, for the occurrence of pacemaker inhibition (215 VVI, 15 VVI Activitrax and 22 DDD, from 9 different manufacturers). Inhibition was observed in 75 (34.9%) of the conventional VVI, in 4 (26.6%) of the VVI Activitrax and in 17 (77.3%) of the DDD paced patients. It was found that both the PM and RA were capable of causing inhibition alone in some cases, while in others a synergy of the two groups was required. It is clear that the RA must always be considered as a possible serious source of inhibiting myopotentials, irrespective of the location of the pacemaker. The most effective exercise for eliciting PM exertion was pulling the flexed arm towards the chest against resistance, while in the supine position. For RA exertion, the best exercise was raising the head and trunk from the supine position and holding the trunk at an angle of about 30 degrees to the horizontal. Both these exercises gave good, consistently reproducible results.
标准运动测试通常不足以揭示与骨骼肌肌电位相关的感知过度问题的本质。在一项针对大量起搏患者的研究中，我们使用了专门设计的运动，以特别测试腹直肌（RA）和胸大肌（PM）肌群。我们总共检查了252名起搏患者，无论有无症状且起搏节律稳定，以观察起搏器抑制的发生情况（其中215例VVI、15例VVI Activitrax和22例DDD，来自9个不同制造商）。在传统VVI起搏患者中，有75例（34.9%）观察到抑制现象；在VVI Activitrax起搏患者中，有4例（26.6%）；在DDD起搏患者中，有17例（77.3%）。结果发现，在某些情况下，PM和RA都能够单独引起抑制，而在其他情况下，则需要两组协同作用。显然，无论起搏器的位置如何，RA都必须始终被视为抑制肌电位的一个可能的严重来源。引发PM用力的最有效运动是在仰卧位时将弯曲的手臂向胸部对抗阻力牵拉。对于RA用力，最佳运动是从仰卧位抬起头部和躯干，并将躯干保持在与水平面约30度的角度。这两种运动都产生了良好的、可重复的一致结果。
