Lau C P, Tai Y T, Leung S K, Leung W H, Chung F L, Lee I S
Department of Medicine, Queen Mary Hospital, University of Hong Kong.
Pacing Clin Electrophysiol. 1994 Nov;17(11 Pt 2):1849-53. doi: 10.1111/j.1540-8159.1994.tb03761.x.
Optimal function of a single lead P wave synchronous rate adaptive ventricular pacing system (VDDR) requires reliable P wave sensing over time and during daily activities. The stability of P wave sensing and the incidence of sensitivity reprogramming in a single pass lead with a diagonally arranged bipole was assessed in 30 patients with complete atrioventricular block over a follow-up period of 12 +/- 1 months (range 6 months to 3 years). Atrial sensing was assessed during clinic visits, by physical maneuvers (postural changes, breathing, Valsalva maneuver, walking and isometric exercise), maximum treadmill exercise and Holter recordings. P wave amplitude at implantation was 1.21 +/- 0.09 (0.5-3.6) mV, and the atrial sensing threshold remained stable over the entire period of follow-up. Using an atrial sensitivity based on twice the sensing threshold at 1 month, P wave undersensing was found in 2, 4, 3, and 7 patients during clinic visit, physical maneuvers, exercise, and Holter recordings, respectively. Atrial sensitivity reprogramming was performed in three patients based on the correction of undersensing during physical maneuvers. Although eight patients had atrial undersensing on Holter recordings, the number of undersensed P waves was small (total 101 beats or 0.013% +/- 0.001% of total ventricular beats) and no patient was symptomatic. One patient had intermittent atrial undersensing at the highest sensitivity, but the VDDR mode was still functional most of the time. No patient had myopotential interference at the programmed sensitivity. One patient developed chronic atrial fibrillation and was programmed to the VVIR mode. Thus, single lead VDDR pacing is a stable pacing mode in 97% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
单导联P波同步频率适应性心室起搏系统（VDDR）的最佳功能需要在一段时间内以及日常活动期间可靠地感知P波。在30例完全性房室传导阻滞患者中，对采用对角排列双极的单根导线进行P波感知稳定性和灵敏度重新编程发生率进行了评估，随访期为12±1个月（范围6个月至3年）。在门诊就诊时、通过体格检查（体位改变、呼吸、瓦尔萨尔瓦动作、行走和等长运动）、最大运动平板试验和动态心电图记录来评估心房感知情况。植入时P波振幅为1.21±0.09（0.5 - 3.6）mV，在整个随访期间心房感知阈值保持稳定。采用基于1个月时感知阈值两倍的心房灵敏度，分别在门诊就诊、体格检查、运动和动态心电图记录期间发现2例、4例、3例和7例患者存在P波感知不足。基于体格检查期间感知不足的校正，对3例患者进行了心房灵敏度重新编程。尽管8例患者在动态心电图记录中存在心房感知不足，但感知不足的P波数量很少（共101次搏动，占心室总搏动的0.013%±0.001%），且无患者出现症状。1例患者在最高灵敏度时存在间歇性心房感知不足，但VDDR模式在大多数时间仍能正常工作。在设定的灵敏度下，无患者出现肌电位干扰。1例患者发生慢性心房颤动，被程控为VVIR模式。因此，单导联VDDR起搏在97%的患者中是一种稳定的起搏模式。（摘要截选至250字）
