心室起搏管理对病态窦房结综合征患者心功能的影响  

Effect of Managed Ventricular Pacing on Heart Function in Patients with Sick Sinus Syndrome

作　　者：曹佳齐[1] 顾水明[2] 徐亚伟[1] 

机构地区：[1]同济大学附属第十人民医院心内科,上海200072 [2]上海市徐汇区中心医院心内科,上海200031

出　　处：《中国临床医学》2013年第6期840-842,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:观察心室起搏管理(managed ventricular pacing,MVP)对病态窦房结综合征(sick sinus syndrome,SSS)患者心功能的影响。方法:42例植入具有MVP功能的双腔起搏器(Medtronic Adapta ADD01/ADDR01/ADDRL1)的SSS患者,先以双腔起搏(DDD/R)模式工作6个月,再程控为MVP模式工作6个月,统计两种模式下右心室起搏比例,并比较两种模式下患者心功能的变化。结果:在DDD/R模式下,平均右心室心尖部起搏比例达43.6%,左心室射血分数(left ventricular ejection fraction,LVEF)从(56.5±2.6)%下降至(54.1±3.0)%(P=0.001),左心室舒张末期直径(left ventricular end-diastolic diameter,LVEDD)从(49.6±2.6)mm升高至(51.4±2.4)mm(P=0.002),B型利钠肽(B-type natriuretic peptide,BNP)从(77.0±16.2)pg/mL升高至(87.2±16.4)pg/mL(P=0.032)。在MVP模式下,平均右心室心尖部起搏比例仅为1.8%,LVEF从(54.1±3.0)%上升至(55.4±1.4)%(P=0.042),LVEDD从(51.4±2.4)mm下降至(50.2±2.0)mm(P=0.016),BNP从(87.2±16.4)pg/mL下降至(86.5±14.9)pg/mL(P=0.852)。另外,DDD/R模式下有4例患者发生阵发性心房颤动,而MVP模式下仅1例发生阵发性心房颤动,但差异无统计学意义(P=0.180)。结论:与DDD/R模式比较,MVP模式能显著减少右心室起搏比例,且对心功能有较好的保护作用。Objective：To study the effect of managed ventricular pacing（MVP） on heart function in patients with sick sinus syndrome（SSS）.Methods：Pacemakers with MVP algorithm were implanted in 42 patients with SSS.Conventional DDD/R mode had been programmed in the first 6 months,and then MVP algorithm had been programmed in the next 6 months.Right ventricular pacing proportions were calculated,and the heart function changes were compared between the two modes during 6 month follow-up.Results：During DDD/R mode,the mean value of cumulative right ventricular pacing proportion was 43.6％;left ventricular ejection fraction（LVEF） decreased from（56.5-± 2.6） ％ to （54.1 ± 3.0） ％ （P =0.001） ; left ventricular enddiastolic diameter（LVEDD） increased from（49.6-± 2.6）mm to （51.4 ± 2.4）mm（P =0.002） ; B-type natriuretic peptide（BNP）increased from （77.0 ± 16.2） pg/mL to （87.2 ± 16.4）pg/mL（P =0.032）.During MVP algorithm,the mean value of cumulative right ventricular pacing proportion was 1.8％; LVEF increased from （54.1 ± 3.0）％ to （55.4 ± 1.4）％ （P =0.042）;LVEDD decreased from （51.4 ± 2.4）mm to （50.2-± 2.0）mm（P =0.016） ; BNP decreased from （87.2 ± 16.4） pg/mL to （86.5± 14.9）pg/mL（P =0.852）.In addition,paroxysmal atrial fibrillation was found in 4 cases in the DDD/R mode,and 1 case in the MVP algorithm（P =0.180）.Conclusions：Compared with conventional DDD/R mode,MVP algorithm significantly reduces the cumulative right ventricular pacing proportion,and it can protect heart function better.

关 键 词：心室起搏管理 病态窦房结综合征 心功能 

分 类 号：R541.74[医药卫生—心血管疾病]