Lau C P, Tai Y T, Leung W H, Wong C K, Lee P, Chung F L
Department of Medicine, University of Hong Kong, Queen Mary Hospital.
Eur Heart J. 1994 Nov;15(11):1445-55. doi: 10.1093/oxfordjournals.eurheartj.a060413.
An atrial-based pacing mode is superior to ventricular constant rate demand pacing (VVI) mode in patients with sick sinus syndrome (SSS) by providing both rate adaptation and atrioventricular (AV) synchrony. The use of a non-atrial sensor to overcome chronotropic incompetence and preserve normal intrinsic AV conduction in pacemaker therapy for SSS was investigated in 15 consecutive patients (mean age 66 +/- 2 years). All had intact AV conduction (antegrade conduction capacity > 100 beats.min-1 and an atrial paced to intrinsic R interval of < or = 220 ms). DDDR pacemakers capable of being programmed into atrial rate adaptive (AAIR), dual chamber rate adaptive (DDDR) and ventricular rate adaptive (VVIR) modes were used. Beginning with an acute study, arterial pressure was invasively assessed in each pacing mode during physiological stresses and low level exercise. In the ambulatory phase, the incidence of ventricular pacing and arrhythmias (Holter recording), diurnal blood pressure changes (ambulatory blood pressure recording), and symptom and quality of life level (questionnaires and interviews) were compared. Despite similar heart rate changes during acute physiological stresses, a higher blood pressure was recorded during AAIR or DDDR pacing compared with VVIR pacing. Systolic blood pressure over 24 h was lower in the VVIR mode (122 +/- 5 mmHg) than AAIR/DDDR pacing (129 +/- 6/128 +/- 6 mmHg, P < 0.05). VVIR pacing was associated with a higher frequency of atrial and ventricular ectopics, with two patients developing paroxysmal atrial fibrillation. Ventricular pacing was used in a higher percentage in the DDDR compared with the VVIR mode (64 +/- 11 and 39 +/- 7%, P < 0.03). VVIR pacing was associated with more palpitations, a lower level of general well being and depression. Despite the use of a sensor to overcome chronotropic incompetence, VVIR pacing is a less satisfactory pacing mode for SSS. Although AAIR/DDDR pacing may achieve similar haemodynamic and clinical status, in patients with intact AV conduction, AAIR pacing may be preferable by avoiding an abnormal ventricular activation pattern.
在病态窦房结综合征（SSS）患者中，基于心房的起搏模式通过提供心率适应性和房室（AV）同步性，优于心室按需恒定频率起搏（VVI）模式。我们对15例连续患者（平均年龄66±2岁）进行了研究，探讨在SSS的起搏器治疗中使用非心房传感器来克服变时性功能不全并保留正常的固有房室传导。所有患者的房室传导均完整（前传传导能力>100次/分钟，心房起搏至固有R间期≤220毫秒）。使用了能够程控为心房频率适应性（AAIR）、双腔频率适应性（DDDR）和心室频率适应性（VVIR）模式的DDDR起搏器。从急性研究开始，在生理应激和低水平运动期间，对每种起搏模式进行有创动脉压评估。在动态监测阶段，比较心室起搏和心律失常的发生率（动态心电图记录）、日间血压变化（动态血压记录）以及症状和生活质量水平（问卷调查和访谈）。尽管在急性生理应激期间心率变化相似，但与VVIR起搏相比，AAIR或DDDR起搏时记录到的血压更高。24小时收缩压在VVIR模式下（122±5 mmHg）低于AAIR/DDDR起搏（129±6/128±6 mmHg，P<0.05）。VVIR起搏与心房和心室异位搏动的频率较高相关，有2例患者发生阵发性心房颤动。与VVIR模式相比，DDDR模式下心室起搏的使用百分比更高（64±11%和39±7%，P<0.03）。VVIR起搏与更多心悸、较低的总体健康水平和抑郁相关。尽管使用了传感器来克服变时性功能不全，但对于SSS患者，VVIR起搏是一种不太理想的起搏模式。虽然AAIR/DDDR起搏可能实现相似的血流动力学和临床状态，但在房室传导完整的患者中，AAIR起搏通过避免异常的心室激动模式可能更可取。
