Fröhlig G, Sen S, Rettig G, Schieffer H, Bette L
Z Kardiol. 1985 Sep;74(9):537-47.
136 patients were followed after implantation a DDD pacemaker (PM) for a total of 1,919 patient-months (m = 14.1 months/patient). 22/136 patients had one or more episodes of atrial flutter or fibrillation (AF) postoperatively. In 121/136 patients (group A) AF had not been documented before, in 4 it was unknown at the time of implantation, but was verified retrospectively (group B). 11 patients (group C) had a positive history of previous AF. Post implantation 7.4% in group A and 81.8% in group C developed AF. In patients with sick sinus syndrome (SSS) the incidence was 10/37 (27%), in those with AV block (AV) 6/77 (7.8%) and in cases with both SSS and AV 6/22 (27.3%). The first AF episode occurred during the implantation itself (n = 2) or during the hospital course in 9/22 patients (A: 11%, B/C: 64% early attacks), and later on in 13 with a time delay of 1-24 months (m = 8.5, 8 patients) in group A and 2-15 months (m = 6.6, 4 patients) in groups B/C. 2 patients of group C had no AF episodes post implantation. In the individual patient the number of attacks ranged from 1 to 3 (10.4/100 patient-months) in group A and from 1 to 6 (20.1/100 patient-months) in groups B/C. During AF 16/22 patients had a ventricular rate of 110-185, m = 132 bpm. In 6 patients the tachycardia was mediated by the PM and in 10 by fast intrinsic AV conduction. 1 patient with SSS, 2 with SSS + AV (spontaneous ventricular rate less than 45 bpm) and 3 with AV needed ventricular backup-pacing during AF. In 7 patients a total of 15 attacks of atrial flutter could be terminated by atrial overdrive pacing, in 5 of these episodes by temporary high rate A00 stimulation via the implanted pacemaker lead system. Otherwise AF was converted to sinus rhythm by antiarrhythmic drugs. After termination AF often recurred, but only 3 patients developed chronic atrial fibrillation. In 2 patients a ventricular rate greater than 180 bpm during AF reverted the PM to asynchronous mode, a possible cause of ventricular fibrillation in one. No other complications due to the PM itself have been encountered. AF, therefore, common during DDD pacing, even in patients without any AF history before implant. Both the incidence and the recurrence of AF depend on the presence or absence of previous atrial arrhythmias.(ABSTRACT TRUNCATED AT 400 WORDS)
136例患者植入双腔起搏器（PM）后随访，共计1919患者月（平均14.1月/患者）。136例患者中有22例术后发生1次或多次心房扑动或心房颤动（AF）。136例患者中121例（A组）术前无AF记录，4例植入时未知，但回顾性证实有AF（B组）。11例患者（C组）既往有AF病史。植入后A组AF发生率为7.4%，C组为81.8%。病态窦房结综合征（SSS）患者中AF发生率为10/37（27%），房室传导阻滞（AV）患者中为6/77（7.8%），SSS合并AV患者中为6/22（27.3%）。首次AF发作发生在植入过程中（n = 2）或住院期间，9/22例患者如此（A组：11%，B/C组：64%为早期发作），之后13例发作时间延迟1 - 24个月（平均8.5个月，8例），A组如此，B/C组延迟2 - 15个月（平均6.6个月，4例）。C组2例患者植入后无AF发作。A组个体患者发作次数为1至3次（10.4/100患者月），B/C组为1至6次（20.1/100患者月）。AF发作时，22/22例患者心室率为110 - 185次/分，平均132次/分；6例患者心动过速由PM介导，10例由快速固有房室传导介导。1例SSS患者、SSS + AV患者2例（自发心室率小于45次/分）及AV患者3例AF发作时需要心室备用起搏。7例患者共15次心房扑动发作可通过心房超速起搏终止，其中5次发作通过植入起搏器导线系统进行临时高频率A00刺激终止。否则AF通过抗心律失常药物转为窦性心律。AF终止后常复发，但仅3例患者发展为慢性心房颤动。2例患者AF发作时心室率大于180次/分导致PM转为非同步模式，可能导致其中1例患者发生心室颤动。未遇到因PM本身导致的其他并发症。因此，即使术前无AF病史，DDD起搏期间AF也很常见。AF的发生率和复发均取决于既往是否存在房性心律失常。（摘要截短至400字）
