Schuchert A, Schmidt W, Jakob M, Jung W, Karmann W, Kreuzer J, Staedt U, Stertmann W A, Treese N, Meinertz T
Abteilung für Kardiologie, Universitäts-Krankenhaus Eppendorf, Hamburg.
Dtsch Med Wochenschr. 1997 Oct 24;122(43):1303-7. doi: 10.1055/s-2008-1047763.
Implantation of a VDD pacemaker (ventricular pacing; dual sensing [atrial and ventricular]; dual response [triggered + inhibited]) together with a single VDD electrode catheter restores synchronous AV ventricular stimulation in patients with higher-grade AV block and intact sinus function. If higher-frequency stimulation occurs it may be a sign of pacemaker malfunction or of inadequate pacemaker programming. This study was undertaken to determine, at first follow-up examination, in how many patients with a VDD pacemaker VVI stimulation occurred more than 5% of the time; how such patients differed from those with 5% or fewer VVI stimulations; and whether a changed program reduced the proportion of VVI stimulations.
67 consecutive patients were tested 1 to 3 months after implantation of the Unity VDD pacemaker (Sulzer Intermedics). The frequency of VVI stimulations was determined via a diagnostic pacemaker memory store. After intermediate analysis, programming was optimized and the patients then re-tested 12 months after the initial implantation.
At the first follow-up examination 54 patients had VVI stimulations of < or = 5% (0.5 +/- 0.9%) and 13 had > 5% of the time (19.8 +/- 10.7%). The two groups differed significantly from one another in their lower intervention frequency (< or = 5% VVI stimulations: 47 +/- 6/min; > 5% VVI stimulations: 58 +/- 5/min). In particular, the pacemakers in patients with > 5% VVI stimulations had been significantly more often programmed to values of > 50/min. As a result, the pacemakers of these patients were reprogrammed to a lower frequency. A year after implantation there was no longer any difference in the lower intervention frequency, 44 +/- 4/min, between patients with initially > 5% VVI stimulations and those with initially < or = 5% stimulations. At the same time, the proportion of VVI stimulations fell to 4 +/- 6%, with 67% of patients having AV synchronicity of > 95%.
At first follow-up, patients with > 5% VVI stimulations differed from those with < or = 5% stimulations with regard to an increased lower intervention frequency. In most of these patients the proportion of AV stimulations was increased to > 95% by reducing the lower intervention frequency to < or = 50/min.
植入VDD起搏器（心室起搏；双感知[心房和心室]；双反应[触发+抑制]）并结合单个VDD电极导管，可恢复高度房室传导阻滞且窦房功能正常患者的房室同步刺激。如果出现高频刺激，可能是起搏器故障或起搏器程控不当的迹象。本研究旨在首次随访检查时确定，在植入VDD起搏器的患者中，有多少患者VVI刺激发生时间超过5%；此类患者与VVI刺激发生时间为5%或更少的患者有何不同；以及程控改变是否会降低VVI刺激的比例。
连续67例患者在植入Unity VDD起搏器（苏尔寿医电公司）后1至3个月接受检测。通过诊断性起搏器内存存储确定VVI刺激的频率。经过中期分析后，优化程控，然后在首次植入后12个月对患者重新进行检测。
在首次随访检查时，54例患者的VVI刺激时间≤5%（0.5±0.9%），13例患者的VVI刺激时间>5%（19.8±10.7%）。两组患者的较低干预频率存在显著差异（VVI刺激时间≤5%：47±6次/分钟；VVI刺激时间>5%：58±5次/分钟）。特别是，VVI刺激时间>5%的患者的起搏器被程控到>50次/分钟的频率显著更多。因此，这些患者的起搏器被重新程控到较低频率。植入一年后，最初VVI刺激时间>5%的患者与最初VVI刺激时间≤5%的患者之间的较低干预频率不再有差异，为44±4次/分钟。同时，VVI刺激的比例降至4±6%，67%的患者房室同步性>95%。
在首次随访时，VVI刺激时间>5%的患者与VVI刺激时间≤5%的患者相比，较低干预频率增加。在大多数此类患者中，通过将较低干预频率降至≤50次/分钟，房室刺激的比例增加到>95%。
