Halperin J L, Camuñas J L, Stern E H, Rothlauf E B, Kupersmith J, Estioko M R, Mace R C, Steinmetz M Y, Teichholz L E
Am J Cardiol. 1984 Jul 1;54(1):97-102. doi: 10.1016/0002-9149(84)90311-4.
Skeletal myopotentials may inhibit the output of unipolar demand ventricular pacemakers, resulting in protracted episodes of asystole in susceptible patients. The new DDD-mode pacemakers have, in addition to a unipolar ventricular lead, a unipolar atrial lead to enable atrioventricular sequential or atrial synchronous function. During clinical investigation of a new dual-unipolar cardiac pacing system programmed to operate in the DDD mode (Pacesetter AFP models 281 and 283), 6 patients were noted (5 men and 1 woman, aged 22 to 68 years) who manifested paroxysmal acceleration of ventricular pacing rate approaching the maximal tracking rate. Two patients also had abrupt slowing or cessation of ventricular output. With the use of atrial electrographic recordings (obtained with telemetry), the following mechanisms of rate change were found: myopotential tracking, myopotential inhibition, interference-mode asynchronous operation, sudden increases in sinus rate, and pacemaker-mediated reentrant tachycardia. In all patients, reprogramming of the implanted devices, based on telemetered atrial electrography, resulted in disappearance of the arrhythmias and loss of symptoms while maintaining the DDD pacing mode. Thus, several mechanisms of rhythm disturbances are peculiar to dual-chamber cardiac pacing systems that use unipolar electrodes. Endocardial telemetry combined with extensive programming capability offers the best opportunity for proper diagnosis and management of these problems.
骨骼肌电位可能会抑制单极按需型心室起搏器的输出，导致易感患者出现长时间的心搏停止发作。新型DDD模式起搏器除了有一根单极心室导线外，还有一根单极心房导线，以实现房室顺序起搏或心房同步功能。在对一种新的双单极心脏起搏系统进行临床研究时，该系统被编程为以DDD模式运行（Pacesetter AFP型号281和283），发现有6例患者（5名男性和1名女性，年龄22至68岁）表现出心室起搏率阵发性加速，接近最大跟踪率。两名患者还出现了心室输出突然减慢或停止的情况。通过使用心房电图记录（通过遥测获得），发现了以下心率变化机制：肌电位跟踪、肌电位抑制、干扰模式异步运行、窦性心率突然增加以及起搏器介导的折返性心动过速。在所有患者中，基于遥测心房电图对植入设备进行重新编程后，心律失常消失，症状缓解，同时保持了DDD起搏模式。因此，使用单极电极的双腔心脏起搏系统存在几种特殊的节律紊乱机制。心内膜遥测结合广泛的编程能力为这些问题的正确诊断和处理提供了最佳机会。
