Saksena S, Delfaut P, Prakash A, Kaushik R R, Krol R B
Arrhythmia & Pacemaker Service, Eastern Heart Institute, Passaic, New Jersey, USA.
J Cardiovasc Electrophysiol. 1998 Aug;9(8 Suppl):S155-62.
There is increasing evidence that single site atrial pacing is beneficial for atrial fibrillation (AF) prevention in sick sinus syndrome. Multisite atrial pacing methods such as dual site right atrial pacing and biatrial synchronous pacing are currently under active evaluation for AF and atrial flutter prevention in patients with or without bradyarrhythmias. Clinical studies have demonstrated that multisite atrial pacing has an incremental benefit as compared with single site right and left atrial pacing. The electrophysiologic rationale for the efficacy of multisite atrial pacing is based on the reduction of global and local atrial activation times during pacing and for closely coupled atrial premature beats. This results in earlier recovery of excitability and decreased conduction delay. Dual site right atrial pacing consisting of simultaneous pacing from the high right atrium and the coronary sinus ostium reduces the activation times in virtually all left and right atrial regions, especially in areas of conduction delay. Multisite pacing methods reduce the ability to initiate AF with atrial premature beats by reducing the window for AF induction and minimizing the dispersion of atrial refractoriness. In our long-term clinical experience including 30 patients with paroxysmal and chronic drug-refractory AF, 78% of the patients were free of AF recurrence at 1 year, 63% at 2 years, and 56% at 3 years. Rhythm control was achieved in 86% of patients during a follow-up period of 3 years. Concomitantly, we observed a marked reduction in need for anticoagulation, type I antiarrhythmic drugs, and cardioversion therapies. There were no coronary sinus lead-related complications during follow-up. After the initial favorable clinical experiences, two major prospective randomized trials (DAPPAF and SYNBIAPACE) are under way in North America and Europe to evaluate quantitatively the beneficial impact of multisite atrial pacing for AF prevention.
越来越多的证据表明，单部位心房起搏对预防病态窦房结综合征患者的心房颤动（AF）有益。目前正在积极评估多部位心房起搏方法，如双部位右心房起搏和双心房同步起搏，用于预防有或无缓慢性心律失常患者的AF和心房扑动。临床研究表明，与单部位右心房和左心房起搏相比，多部位心房起搏具有额外的益处。多部位心房起搏疗效的电生理原理基于起搏期间整体和局部心房激动时间的缩短以及紧密耦合的房性早搏。这导致兴奋性更早恢复和传导延迟减少。由高位右心房和冠状窦口同时起搏组成的双部位右心房起搏几乎可缩短所有左、右心房区域的激动时间，尤其是在传导延迟区域。多部位起搏方法通过减少AF诱发窗口和最小化心房不应期离散度，降低了房性早搏引发AF的能力。在我们纳入30例阵发性和慢性药物难治性AF患者的长期临床经验中，78%的患者在1年时无AF复发，2年时为63%，3年时为56%。在3年的随访期内，86%的患者实现了节律控制。同时，我们观察到抗凝、I类抗心律失常药物和心脏复律治疗的需求显著减少。随访期间未出现与冠状窦导联相关的并发症。在最初取得良好临床经验后，北美和欧洲正在进行两项主要的前瞻性随机试验（DAPPAF和SYNBIAPACE），以定量评估多部位心房起搏对预防AF的有益影响。
