Geelen P, Lorga Filho A, Chauvin M, Wellens F, Brugada P
Cardiovascular Center, O.L.V.-Hospital, Aalst, Belgium.
Pacing Clin Electrophysiol. 1997 Jan;20(1 Pt 2):177-81. doi: 10.1111/j.1540-8159.1997.tb04838.x.
Although the beneficial effects of DDD pacing are well known, currently available ICDs provide only fixed rate ventricular antibradycardia pacing. In a consecutive series of 139 patients with ICDs, we have analyzed the need for antibradycardia pacing and the indications for DDD pacing. We also report our initial experience with the Defender 9001 (ELA Medical, France) DDD-ICD. Out of 139 patients, 25 (18%) were in need of antibradycardia pacing. Ten patients already had a pacemaker at the time of ICD implantation and ten other patients had a conventional pacemaker indication at that time. Five patients became pacemaker dependent during a follow-up of 20 +/- 8 months. The disorders necessitating pacemaker therapy were high degree AV conduction disturbances in 72%, sick sinus syndrome in 12%, and AF with a slow ventricular response in 16% of patients. Based upon current indications, DDD pacing was indicated in 20 (80%) of 25 patients. The Defender 9001 DDD-ICD (ELA Medical) was used in two patients with ischemic cardiomyopathy and pacemaker syndrome with VVI pacing. Cardiac output during DDD pacing increased by 36% in one patient with an increase in VO2 max during exercise of 29%. The other patient showed an increase in cardiac output of 50% with DDD pacing, and, while unable to exercise with VVI pacing, had a VO2max of 24 mL/kg per minute during DDD pacing. Up to 18% of our ICD patients are in need of antibradycardia pacing. Of these pacemaker dependent patients, 80% have an indication for DDD pacing. Our first clinical experience with a DDD-ICD confirms the hemodynamic benefit of AV synchronous pacing in ICD patients with pacemaker syndrome.
尽管双腔（DDD）起搏的有益效果已广为人知，但目前可用的植入式心脏除颤器（ICD）仅提供固定频率的心室抗心动过缓起搏。在连续的139例ICD患者系列中，我们分析了抗心动过缓起搏的需求以及DDD起搏的指征。我们还报告了使用Defender 9001（法国ELA Medical公司）DDD-ICD的初步经验。在139例患者中，25例（18%）需要抗心动过缓起搏。10例患者在植入ICD时已安装起搏器，另外10例患者当时有传统起搏器植入指征。在20±8个月的随访期间，5例患者变得依赖起搏器。需要起搏器治疗的疾病中，72%为高度房室传导阻滞，12%为病态窦房结综合征，16%为伴有缓慢心室反应的房颤。根据当前指征，25例患者中有20例（80%）适合DDD起搏。两名患有缺血性心肌病和VVI起搏导致的起搏器综合征的患者使用了Defender 9001 DDD-ICD（ELA Medical公司）。一名患者在DDD起搏时心输出量增加了36%，运动时最大摄氧量增加了29%。另一名患者在DDD起搏时心输出量增加了50%，在VVI起搏时无法运动，而在DDD起搏时最大摄氧量为每分钟24 mL/kg。我们的ICD患者中高达18%需要抗心动过缓起搏。在这些依赖起搏器的患者中，80%有DDD起搏指征。我们使用DDD-ICD的首次临床经验证实了房室同步起搏对患有起搏器综合征的ICD患者的血流动力学益处。
