Lascault G, Barnay C, Cazeau S, Frank R, Medvedowsky J L
Hôpital Jean Rostand, Ivry sur Seine, France.
Pacing Clin Electrophysiol. 1995 Sep;18(9 Pt 1):1636-43. doi: 10.1111/j.1540-8159.1995.tb06985.x.
Unexplained syncope is the main indication for the implantation of a diagnostic pacemaker. Studies on those implanted have shown that in patients with unexplained syncope, the diagnosis of paroxysmal bradycardia was feasible and reliable. The present study was designed to evaluate a new bradycardia diagnosis algorithm, loaded in a dual chamber pacemaker, in 24 patients considered as candidates for diagnostic pacemakers. During a mean follow-up of 153 days, at least one bradycardia episode was recorded in 13 patients. The mean number of detected bradycardias was 6 and the median was 3. The mean delay between the algorithm activation and the first bradycardia episode was 67 days. The mechanism of bradycardia was atrioventricular block in 6 patients, sinus node dysfunction in 6 patients, and consecutive blocked atrial premature beats in 1 patient, as indicated by the event markers. In 11 patients bradycardia was recorded during the daytime only or day and night. In two patients the episodes were recorded only at night. Overall, the algorithm was well-tolerated; however, some mild symptoms were observed due to the method of bradycardia determination, allowing bradycardia. Three patients were symptomatic as a direct result of the algorithm operation, and four patients had symptoms related to the single chamber operation of the pacemaker while functioning in the diagnosis mode (VDI). These symptoms were relieved with DDD pacing.
不明原因晕厥是植入诊断性起搏器的主要指征。对已植入起搏器患者的研究表明，对于不明原因晕厥患者，阵发性心动过缓的诊断是可行且可靠的。本研究旨在评估一种加载于双腔起搏器中的新型心动过缓诊断算法，研究对象为24例被视为诊断性起搏器植入候选者的患者。在平均153天的随访期间，13例患者记录到至少一次心动过缓发作。检测到的心动过缓平均次数为6次，中位数为3次。算法激活至首次心动过缓发作的平均间隔时间为67天。事件标记显示，6例患者心动过缓机制为房室传导阻滞，6例为窦房结功能障碍，1例为连续的房性早搏阻滞。11例患者仅在白天或白天及夜间记录到心动过缓。2例患者仅在夜间记录到发作。总体而言，该算法耐受性良好；然而，由于心动过缓的判定方法，观察到一些轻微症状，即允许心动过缓。3例患者因算法操作直接出现症状，4例患者在起搏器以诊断模式（VDI）单腔工作时出现与起搏器相关的症状。这些症状在DDD起搏时缓解。
