Nowak B, Voigtländer T, Rosocha S, Liebrich A, Zellerhoff C, Przibille O, Geil S, Himmrich E, Meyer J
II. Medical Clinic, Johannes-Gutenberg-University, Mainz, Germany.
Pacing Clin Electrophysiol. 1998 Oct;21(10):1927-33. doi: 10.1111/j.1540-8159.1998.tb00012.x.
Dual chamber rate responsive pacing incorporating a mode switching option is increasingly used in patients with chronic paroxysmal atrial fibrillation and high degree AV block. Single-lead VDDR pacemakers have rarely used for this indication. The purpose of this study was to determine their reliability of atrial sensing during atrial fibrillation, the percentage of atrial synchronous ventricular pacing, and the behavior of the sinus rate outside the phases of atrial fibrillation. We studied ten patients with a single-lead VDDR pacemaker implanted for this indication. Follow-up visits were performed at predischarge and after 1, 3, 6, 12, 18, and 24 months. During the mean follow-up period of 18.9 +/- 6.9 months, the atrial sensing thresholds in sinus rhythm remained stable. Atrial synchronous ventricular stimulation was achieved in 68.7 +/- 31.2% (median 82.5%) of the whole follow-up time. All patients showed an adequate atrial rate response during sinus rhythm. Atrial fibrillation was detected by the pacemakers in 24.0 +/- 29.8% of time. In 3 of 10 patients the duration of atrial fibrillation showed a steady increase from visit to visit. The sensed amplitudes of atrial fibrillation ranged from 0.1-1.0 mV. A programmed atrial sensitivity of 0.1 mV was necessary to achieve complete sensing of atrial fibrillation. None of the patients experienced tachycardias with optimized pacemaker programming. Single-lead VDDR pacing incorporating a mode-switching option is useful in patients with high degree AV block and paroxysmal atrial fibrillation, since it provides atrial synchronous ventricular pacing in more than two-thirds of follow-up time. In a subgroup of patients, a progressive increase of the time during atrial fibrillation was demonstrated. A reliable detection of paroxysmal atrial fibrillation requires the programming of the atrial sensitivity to its most sensitive value.
具有模式转换功能的双腔频率应答起搏越来越多地应用于慢性阵发性心房颤动和高度房室传导阻滞患者。单导联VDDR起搏器很少用于这一适应证。本研究的目的是确定其在心房颤动时心房感知的可靠性、心房同步心室起搏的百分比以及心房颤动阶段以外的窦性心律表现。我们研究了10例因该适应证植入单导联VDDR起搏器的患者。在出院前以及术后1、3、6、12、18和24个月进行随访。在平均18.9±6.9个月的随访期间，窦性心律时的心房感知阈值保持稳定。在整个随访时间的68.7±31.2%（中位数82.5%）实现了心房同步心室刺激。所有患者在窦性心律时均表现出足够的心房率反应。起搏器在24.0±29.8%的时间内检测到心房颤动。10例患者中有3例心房颤动持续时间逐次随访呈稳步增加。心房颤动时感知到的振幅范围为0.1 - 1.0 mV。为实现对心房颤动的完全感知，心房程控灵敏度需设置为0.1 mV。优化起搏器程控后，无一例患者发生心动过速。具有模式转换功能的单导联VDDR起搏对于高度房室传导阻滞和阵发性心房颤动患者是有用的，因为它在超过三分之二的随访时间内提供心房同步心室起搏。在一组患者中，显示心房颤动期间的时间呈进行性增加。可靠检测阵发性心房颤动需要将心房灵敏度程控到最敏感值。
