Lau C P, Jiang Z Y, Tang M O
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Pacing Clin Electrophysiol. 1998 Mar;21(3):542-8. doi: 10.1111/j.1540-8159.1998.tb00096.x.
To assess the effect of right ventricular pacing on rate regularity during exercise and daily life activities, 16 patients with sinoatrial disease and chronic atrial fibrillation (AF) were studied. Incremental ventricular pacing was commenced at 40 beats/min until > 95% of ventricular pacing were achieved during supine, sitting, and standing. Thirteen patients also underwent randomized paired submaximal exercise tests in either a fixed rate mode. (VVI) or a ventricular rate stabilization (VRS) mode in which the pacing rate was set manually at 10 beats/min above the average AF rate during the last minute of each exercise stage. The pacing interval for rate regularization was shortest during standing (692 +/- 26 ms) compared with either supine or sitting (757 +/- 30 and 705 +/- 26 ms, respectively, P < 0.05). During exercise VRS pacing significantly increased the maximum rate (119 +/- 5.2 vs 106 +/- 4.2 ms, P < 0.05), percent of ventricular pacing (85% +/- 5% vs 23% +/- 7%, P < 0.05), rate regularity index (5.8% +/- 1.6% vs 13.4% +/- 1.9%, P < 0.05), and maximum level of oxygen consumption (12.4 +/- 0.5 vs 11.3 +/- 0.5 mL/kg, P < 0.05) compared with VVI pacing. There was no change in oxygen pulse or difference in symptom scores in this acute study between the two pacing modes. It is concluded that right ventricular pacing may significantly improve rate regularity and cardiopulmonary performance in patients with chronic AF. This may be incorporated in a pacing device for rate regularization of AF using an algorithm that is rate adaptive to postural and exercise stresses.
为评估右心室起搏对运动及日常生活活动期间心率规整性的影响，对16例患窦房结疾病及慢性心房颤动（房颤）的患者进行了研究。以40次/分钟的频率开始递增性心室起搏，直至在仰卧、坐位及站立位时达到>95%的心室起搏。13例患者还在固定频率模式（VVI）或心室率稳定（VRS）模式下接受了随机配对次极量运动试验，在VRS模式中，在每个运动阶段的最后一分钟将起搏频率手动设置为比房颤平均心率高10次/分钟。与仰卧位或坐位相比，站立位时用于心率规整的起搏间期最短（分别为692±26毫秒、757±30毫秒和705±26毫秒，P<0.05）。运动期间，与VVI起搏相比，VRS起搏显著提高了最大心率（分别为119±5.2次/分钟与106±4.2次/分钟，P<0.05）、心室起搏百分比（85%±5%与23%±7%，P<0.05）、心率规整指数（5.8%±1.6%与13.4%±1.9%，P<0.05）以及最大耗氧量水平（12.4±0.5与11.3±0.5毫升/千克，P<0.05）。在这项急性研究中，两种起搏模式之间的氧脉搏无变化，症状评分也无差异。得出的结论是，右心室起搏可能显著改善慢性房颤患者的心率规整性和心肺功能。这可纳入一种使用对姿势和运动应激具有心率适应性的算法来使房颤心率规整的起搏装置中。
