Channon K M, Hargreaves M R, Cripps T R, Gardner M, Ormerod O J
Department of Cardiology, John Radcliffe Hospital, Oxford, UK.
Q J Med. 1994 Apr;87(4):245-51.
We studied 16 patients aged 77-88 years to determine whether elderly patients gain significant benefit from dual-chamber (DDD) compared with single-chamber ventricular demand (VVI) pacing. The study was designed as a double-blind randomized two-period crossover study--each pacing mode was maintained for 7 days. End points included: (i) overall symptoms scores; (ii) exercise tests related to daily activities; and (iii) perceived level of difficulty (Borg score). The mean symptom score in DDD mode was 7.07 (6.38) vs. 12.27 (7.29) in VVI mode (p < 0.006). Dizziness, breathlessness and fatigue were the most noticed symptoms during VVI pacing. One patient dropped out from follow-up and three patients requested early reprogramming, all from VVI mode. Overall, no patient preferred VVI mode, 11 preferred DDD mode and four expressed no preference. There were significant improvements in all objective test performances in DDD mode. Mean (SD) total Borg scores in DDD mode and VVI mode were 36.57 (5.85) and 41.93 (6.49), respectively (p < 0.002). Ventricular demand pacing in elderly patients with complete heart block is associated with higher symptom scores, reduced exercise ability and greater perceived exercise difficulty compared with dual-chamber pacing.
我们研究了16名年龄在77至88岁之间的患者，以确定与单腔心室按需起搏（VVI）相比，双腔（DDD）起搏对老年患者是否有显著益处。该研究设计为双盲随机两阶段交叉研究，每种起搏模式维持7天。终点包括：（i）总体症状评分；（ii）与日常活动相关的运动测试；（iii）主观难度水平（Borg评分）。DDD模式下的平均症状评分为7.07（6.38），而VVI模式下为12.27（7.29）（p<0.006）。头晕、呼吸急促和疲劳是VVI起搏期间最常见的症状。一名患者退出随访，三名患者要求提前重新编程，均来自VVI模式。总体而言，没有患者偏好VVI模式，11名患者偏好DDD模式，4名患者表示无偏好。DDD模式下所有客观测试表现均有显著改善。DDD模式和VVI模式下的平均（标准差）总Borg评分分别为36.57（5.85）和41.93（6.49）（p<0.002）。与双腔起搏相比，完全性心脏传导阻滞老年患者的心室按需起搏与更高的症状评分、降低的运动能力和更大的主观运动难度相关。
