Channon K M, Hargreaves M R, Gardner M, Ormerod O J
Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom.
Pacing Clin Electrophysiol. 1997 Jan;20(1 Pt 1):25-33. doi: 10.1111/j.1540-8159.1997.tb04808.x.
To noninvasively assess the hemodynamic effects of VVI and DDD pacing modes we measured beat-to-beat arterial blood pressure during VVI and DDD pacing in 30 patients with complete heart block (CHB), using fingertip photoplethysmography. Of these patients, 15 undertook a double-blind cross-over comparison of the symptomatic effects of VVI versus DDD pacing to determine the relationship between blood pressure changes and the occurrence of symptoms suggestive of the pacemaker syndrome during ventricular pacing. Mean (SD) systolic blood pressure was 11.7 (15.4) mmHg lower during VVI pacing compared to DDD pacing (P < 0.0005). The mean (SD) beat-to-beat variability of systolic blood pressure was 5.20 (2.87%) in VVI mode versus 2.12 (1.07%) in DDD mode (P < 0.0000005). In comparison with DDD pacing, the excess of symptoms experienced by patients during VVI pacing did not correlate with the change in mean systolic blood pressure, but was significantly correlated with the increase in beat-to-beat systolic blood pressure variation during VVI pacing (r = 0.58, P = 0.024). We conclude that noninvasive measurement of fingertip arterial beat-to-beat blood pressure is a rapid and simple method of assessing the hemodynamic effect of VVI pacing. Beat-to-beat blood pressure variability was related to symptomatic intolerance of VVI pacing and may have potential utility as an aid to diagnosis or as a predictor of pacemaker syndrome.
为了无创评估VVI和DDD起搏模式的血流动力学效应，我们使用指尖光电容积脉搏波描记法，对30例完全性心脏传导阻滞（CHB）患者在VVI和DDD起搏期间逐搏测量动脉血压。其中15例患者对VVI与DDD起搏的症状性效应进行了双盲交叉比较，以确定心室起搏期间血压变化与起搏器综合征症状出现之间的关系。与DDD起搏相比，VVI起搏期间平均（标准差）收缩压降低了11.7（15.4）mmHg（P<0.0005）。VVI模式下收缩压的平均（标准差）逐搏变异性为5.20（2.87%），而DDD模式下为2.12（1.07%）（P<0.0000005）。与DDD起搏相比，患者在VVI起搏期间出现的症状增加与平均收缩压变化无关，但与VVI起搏期间逐搏收缩压变化增加显著相关（r=0.58，P=0.024）。我们得出结论，无创测量指尖动脉逐搏血压是评估VVI起搏血流动力学效应的一种快速简便的方法。逐搏血压变异性与VVI起搏的症状不耐受有关，可能具有作为诊断辅助手段或起搏器综合征预测指标的潜在用途。
