Palomo A R, Schwartz A M, Trohman R G, Chahine R A, Myerburg R J, Kessler K M
Am J Cardiol. 1986 Jul 1;58(1):100-3. doi: 10.1016/0002-9149(86)90250-x.
Data from 518 consecutive cardiac catheterizations were analyzed to test the value of prophylactic pacemaker insertion during coronary angiography and to compare the incidence of arrhythmic complications in patients with and without pacemakers. In patients without pacing (n = 273), 1 episode of ventricular fibrillation occurred, which responded promptly to defibrillation. Sinus bradycardia (fewer than 30 beats/min for 10 seconds) was recorded in 74 patients (27%) and required treatment in 30 (11%). No patient required or would have benefited from pacemaker placement. Of the 245 patients with prophylactic pacemakers, there was an increased incidence of all ventricular (9 vs 1; p less than 0.013) and supraventricular (5 vs 0; p less than 0.046) arrhythmias. Pacemaker-associated induction of ventricular fibrillation occurred in 2 patients and was clearly related to electrical stimulation during a normally non-vulnerable period of the cardiac cycle. In conclusion, routine prophylactic pacemaker insertion during coronary angiography is not warranted in patients with normal sinus rhythm and normal atrioventricular conduction. More information is needed to determine if pacing is needed in patients with conduction system disease.
对518例连续进行的心导管检查数据进行分析，以测试冠状动脉造影期间预防性植入起搏器的价值，并比较有和没有起搏器的患者心律失常并发症的发生率。在未起搏的患者（n = 273）中，发生了1次心室颤动，经除颤后迅速恢复。74例患者（27%）记录到窦性心动过缓（心率低于30次/分钟持续10秒），其中30例（11%）需要治疗。没有患者需要或会从起搏器植入中获益。在245例预防性植入起搏器的患者中，所有室性心律失常（9例 vs 1例；p < 0.013）和室上性心律失常（5例 vs 0例；p < 0.046）的发生率均有所增加。2例患者发生了起搏器相关的心室颤动诱发，且明显与心动周期中正常非易损期的电刺激有关。总之，对于窦性心律和房室传导正常的患者，冠状动脉造影期间不建议常规预防性植入起搏器。需要更多信息来确定传导系统疾病患者是否需要起搏。
