Amsterdam UMC location University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands.
Amsterdam UMC location University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands.
Heart Lung Circ. 2023 May;32(5):629-637. doi: 10.1016/j.hlc.2023.02.007. Epub 2023 Mar 27.
Bradyarrhythmias are adequately treated with pacemakers. There are different pacing modes (single-chamber, dual-chamber, cardiac resynchronisation therapy [CRT] and conduction system pacing [CSP]) and a choice between leadless or transvenous pacemakers. The expected pacing need is important for determining optimal pacing mode and device type. This study aimed to evaluate atrial pacing (AP) and ventricular pacing (VP) percentages over time for the most common pacing indications.
Included patients were aged ≥18 years with a dual-chamber rate-modulated [DDD(R)] pacemaker implantation and ≥1 year of follow-up at a tertiary centre between January 2008 and January 2020. Baseline characteristics, AP and VP at yearly follow-up visits up to 6 years after implantation were retrieved from the medical records.
A total of 381 patients were included. Primary pacing indications were incomplete atrioventricular block (AVB) in 85 (22%), complete AVB in 156 (41%) and sinus node dysfunction (SND) in 140 (37%) patients. Mean age at implantation was 71±14, 69±17 and 68±14 years, respectively (p=0.23). Median follow-up was 42 months (25-68 months). Overall, AP was highest in SND with median 37% (7%-75%) versus 7% (1%-26%) in incomplete AVB and 3% (1%-16%) in complete AVB (p<0.001); VP was highest in complete AVB with median 98% (43%-100%) versus 44% (7%-94%) in incomplete AVB and 3% (1%-14%) in SND (p<0.001). Ventricular pacing significantly increased over time in patients with incomplete AVB and SND (both p=0.001).
These results confirm the pathophysiology of different pacing indications, causing clear differences in pacing need and expected battery longevity. They may help guide optimal pacing mode and suitability for leadless or physiological pacing.
缓慢性心律失常可以通过起搏器得到充分治疗。存在不同的起搏模式（单腔、双腔、心脏再同步治疗[CRT]和传导系统起搏[CSP]），以及选择无导线或经静脉起搏器。预期的起搏需求对于确定最佳起搏模式和设备类型非常重要。本研究旨在评估最常见起搏适应证随时间推移的心房起搏（AP）和心室起搏（VP）百分比。
纳入的患者年龄≥18 岁，在 2008 年 1 月至 2020 年 1 月期间在三级中心接受了双腔频率适应性[DDD(R)]起搏器植入，并随访至少 1 年。从病历中提取了基线特征、植入后每年随访时的 AP 和 VP。
共纳入 381 例患者。主要起搏适应证为不完全性房室传导阻滞（AVB）85 例（22%）、完全性 AVB 156 例（41%）和窦房结功能障碍（SND）140 例（37%）。植入时的平均年龄分别为 71±14、69±17 和 68±14 岁（p=0.23）。中位随访时间为 42 个月（25-68 个月）。总体而言，SND 的 AP 最高，中位数为 37%（7%-75%），而不完全性 AVB 为 7%（1%-26%），完全性 AVB 为 3%（1%-16%）（p<0.001）；完全性 AVB 的 VP 最高，中位数为 98%（43%-100%），而不完全性 AVB 为 44%（7%-94%），SND 为 3%（1%-14%）（p<0.001）。不完全性 AVB 和 SND 患者的 VP 随时间推移显著增加（均 p=0.001）。
这些结果证实了不同起搏适应证的病理生理学，导致起搏需求和预期电池寿命存在明显差异。它们可能有助于指导最佳起搏模式和无导线或生理性起搏的适用性。
