Dritsas A, Joshi J, Webb S C, Athanassopoulos G, Oakley C M, Nihoyannopoulos P
Department of Medicine Clinical Cardiology, Hammersmith Hospital, Royal Postgraduate School, London, United Kingdom.
Pacing Clin Electrophysiol. 1993 Aug;16(8):1713-8. doi: 10.1111/j.1540-8159.1993.tb01042.x.
To determine whether the magnitude of Beat-to-Beat variability in stroke volume (SV) during VVI pacing can predict hemodynamic benefit from DDD pacing, we undertook Doppler recordings of systolic and diastolic LV flow during VVI and DDD pacing in 20 patients (age 54 +/- 9 years) with DDD pacemakers implanted due to AV block. SV increased by 19% +/- 10% from VVI to DDD (P < 0.01). This increase was greater (29% +/- 9%) in patients with a ratio of early (E)/late (A) filling < 1 compared to those with E/A > 1 (10% +/- 9%) (P < 0.001). Beat-to-Beat variability in SV was greater in VVI (13% +/- 8%) compared to DDD (4% +/- 1%) (P < 0.001). Patients with E/A < 1 showed greater Beat-to-Beat variability in SV during VVI pacing (19 +/- 6%) compared to those with E/A > 1 (8% +/- 4%) (P < 0.001). Beat-to-Beat variability in SV during VVI pacing correlated with both percent change in SV from VVI to DDD (r = 0.89, P < 0.001) and E/A (r = -0.71, P < 0.001). In conclusion, patients with E/A < 1 derive greater hemodynamic benefit at rest from DDD pacing compared with E/A > 1. In addition, patients with complete AV block who show large variations in SV during VVI pacing may obtain greater hemodynamic benefit at rest from DDD pacing than patients with small variations.
为了确定心室按需起搏（VVI）时每搏量（SV）逐搏变化的幅度是否能够预测双腔起搏（DDD）的血流动力学益处，我们对20例（年龄54±9岁）因房室传导阻滞植入DDD起搏器的患者在VVI和DDD起搏期间进行了左心室收缩期和舒张期血流的多普勒记录。SV从VVI起搏到DDD起搏增加了19%±10%（P<0.01）。与E/A>1（10%±9%）的患者相比，舒张早期（E）/舒张晚期（A）充盈率<1的患者增加幅度更大（29%±9%）（P<0.001）。与DDD起搏（4%±1%）相比，VVI起搏时SV的逐搏变化更大（13%±8%）（P<0.001）。与E/A>1（8%±4%）的患者相比，E/A<1的患者在VVI起搏时SV的逐搏变化更大（19±6%）（P<0.001）。VVI起搏时SV的逐搏变化与SV从VVI起搏到DDD起搏的变化百分比（r=0.89，P<0.001）和E/A（r=-0.71，P<0.001）均相关。总之，与E/A>1的患者相比，E/A<1的患者静息时从DDD起搏中获得更大的血流动力学益处。此外，与SV变化小的患者相比，在VVI起搏时SV变化大的完全性房室传导阻滞患者静息时从DDD起搏中可能获得更大的血流动力学益处。
