Ragonese P, Guccione P, Drago F, Turchetta A, Calzolari A, Formigari R
Department of Pediatric Cardiology, Ospedale Bambino Gesù, Research Institute Rome, Italy.
Pacing Clin Electrophysiol. 1994 Apr;17(4 Pt 1):603-10. doi: 10.1111/j.1540-8159.1994.tb02397.x.
Single chamber rate responsive pacing offers many potential advantages over the more complex dual chamber atrial tracking pacing mode in children, and the preservation of atrioventricular synchrony could be unnecessary in selected groups of pediatric patients. Twenty-two pediatric patients (age range 9 months to 12 years; mean 6.5 years) had implantation of ventricular rate responsive (VVIR) pacemakers over a 2-year period. All patients had chronic third-degree atrioventricular block, and a normal ventricular function at rest. During the follow-up each patient underwent a 24-hour Holter monitoring, and ten performed a graded treadmill test in both ventricular fixed rate (VVI) and rate responsive (VVIR) pacing mode. Paced ventricular rates were found to be normal for age in all 22 patients; maximum rate did not reach the higher programmed rate during daily activities in any patient. Comparing the mean paced ventricular rate to the mean rates of blocked P waves, six patients showed a difference of more than 20 beats/min, which induced the pacemaker parameters to be reprogrammed. In all patients a significant correlation was found between variations of paced ventricular rate and variations of spontaneous blocked atrial rhythm (P < 0.05); this correlation persisted in the subsequent Holter controls in the ten patients with longer follow-up. Exercise tolerance resulted normal in the ten patients who performed a treadmill test either in VVIR or VVI mode, with increased maximal heart rates and maximal systolic blood pressure in VVIR mode (P < 0.0013). Rate responsive ventricular pacemakers seem to adequately respond to the physiological needs of daily life of this selected group of children requiring permanent pacing.
对于儿童而言，单腔频率应答式起搏相比更为复杂的双腔心房跟踪起搏模式具有许多潜在优势，并且在特定的儿科患者群体中，保持房室同步可能并非必要。在两年时间里，22名儿科患者（年龄范围为9个月至12岁；平均6.5岁）植入了心室频率应答式（VVIR）起搏器。所有患者均患有慢性三度房室传导阻滞，且静息时心室功能正常。在随访期间，每位患者都接受了24小时动态心电图监测，其中10名患者还在心室固定频率（VVI）和频率应答（VVIR）起搏模式下进行了分级运动平板试验。发现所有22名患者的起搏心室率在年龄上均正常；在任何患者的日常活动中，最大心率均未达到更高的程控心率。将平均起搏心室率与阻滞P波的平均心率进行比较，6名患者的差异超过20次/分钟，这导致起搏器参数被重新程控。在所有患者中，均发现起搏心室率的变化与自发阻滞心房节律的变化之间存在显著相关性（P<0.05）；在随访时间更长的10名患者的后续动态心电图检查中，这种相关性仍然存在。在VVIR或VVI模式下进行运动平板试验的10名患者的运动耐量正常，在VVIR模式下最大心率和最大收缩压增加（P<0.0013）。频率应答式心室起搏器似乎能够充分满足这一特定儿童群体日常生活的生理需求，这些儿童需要永久性起搏。
