起搏器置入后新出现起搏器依赖及右室起搏相关心室不同步研究  

Study on new onset of pacemaker dependency and right ventricular pacing-induced ventricular dyssynchrony afterpermanent pacemaker implantation

作　　者：丁军[1] 吴尚勤[1] 孙姗[1] 程爱娟[1] 李鹏[1] 

机构地区：[1]天津市胸科医院心内七科,天津300051

出　　处：《临床心血管病杂志》2011年第3期168-171,共4页Journal of Clinical Cardiology

摘　　要：目的:研究置入起搏器5年以上患者新出现起搏器依赖及右室起搏相关心室不同步的情况。方法:选取置入时为非起搏器依赖且置入起搏器已超过5年患者272例进行随访,测量自身心率,记录心室起搏比例;将起搏器心室频率逐渐降至30次/min,观察30s,无患者自身心律出现,判定为起搏器依赖;将自身心率<50次/min且心室起搏比例>90%者判定为右室起搏相关心室不同步患者,对起搏器依赖及右室起搏相关心室不同步患者提出个别随访方案和更换建议。结果:136例病窦综合征患者中有4例(2.9%)进展为起搏器依赖;116例房室传导阻滞患者中有10例(8.6%)进展为起搏器依赖;全部病例有15例(5.5%)进展为起搏器依赖;有43例自身心率<50次/min且心室起搏比例>90%,占全部病例的15.8%。结论:房室传导阻滞患者较之病窦综合征患者,更容易进展为起搏器依赖患者;置入起搏器5年以上患者中约有5.5%进展为起搏器依赖;置入起搏器5年以上患者中右室起搏相关心室不同步人群比例约15.8%。Objective：The aim of this study is to examine the incidence of new onset of pacemaker dependency and right ventricular pacing-induced ventricular dyssynchrony 5 years after pacing system implantation.Method：The study included 272 patients who showed intrinsic rhythms at the time of implantation.Measure intrinsic rhythms and record the proportion of ventricular pacing for the cases;Pacemaker dependency was defined as the absence of an intrinsic rhythm for 30 seconds when pacemakers were gradually slowed down to 30 beats/min.Right ventricular pacing-induced ventricular dyssynchrony was defined as 50 beats/min of heart rate and ventricular pacing in proportion of 90%.The patients of pacemaker dependency and right ventricular pacing-induced ventricular dyssynchrony would be given an individual follow-up and advice of pacemaker replacement.Result：New onset of pacemaker dependency was observed in 15（5.5%） of all 272 patients.4（2.9%） of 136 patients with sick sinus syndrome（SSS） also showed the dependent syndrom and 10 cases were also the dependents among 116 cases with atrioventricular block（AV block）.The patients with 50 beats/min of heart rate and right ventricular pacing in proportion of 90% were 43（15.8%） of the 272 cases.Conclusion：The patients with AV block are more likely to become pacemaker dependents than the cases with SSS.The incidence of new onset of pacemaker dependency was about 5.5% after 5-year follow-up.During this period,almost 15.8% cases represented right ventricular pacing-induced ventricular dyssynchrony.

关 键 词：房室传导阻滞 起搏器依赖 心室不同步 病窦综合征 起搏器随访 

分 类 号：R541.7[医药卫生—心血管疾病]