不同心房起搏部位及频率对病态窦房结综合征患者术后房颤发生的影响  

The effect of different atrial pacing site and frequency in preventing postoperative atrial fibrillation in patients with sick sinus syndrome

作　　者：汪贵忠[1] 徐健[1] 

机构地区：[1]安徽医科大学附属省立医院心血管内科,合肥230001

出　　处：《安徽医科大学学报》2014年第7期973-977,共5页Acta Universitatis Medicinalis Anhui

基　　金：安徽省自然科学基金(编号:090413128)

摘　　要：目的探讨低位房间隔起搏及不同起搏频率对病态窦房结综合征患者术后房颤的短期影响,分析其电生理机制。方法 38例病态窦房结综合征患者随机将心房电极植入心耳和低位房间隔,平均随访1年,测量不同心房起搏频率时P波至左房传导时间及左侧房室间期,比较不同心房起搏部位术后房颤发生率。结果 1两组患者术前资料对比无显著差异;2两组间均无并发症,无起搏及感知功能障碍情况发生;3低位房间隔组房颤发生率较右心耳组低,P波至左房传导时间短,左侧房室间期延长,差异有统计学意义;4两组间高起搏频率(80 bpm)较低起搏频率(60 bpm)比较可延长左侧房室间期,差异有统计学意义。结论病态窦房结综合征患者低位房间隔起搏时房颤发生率低,提高心房起搏比例可能伴有协同作用,其机制可能与改善房间传导延缓,延长左侧房室间期,改善心房间、左侧房室同步性有关。Objective To evaluate the short-term effect of low atrial septum pacing and different pacing frequency to prevent atrial fibrillation in patients with sick sinus syndrome . The electrophysiological mechanism would be analyzed. Methods Thirty eight sick sinus syndrome patients were randomly divided to right atrial appendage pacing group and low atrial septum pacing group. The conduction time from P wave to left atrial and left atrioventricular interval was measured at different atrial pacing frequency. The effects of different atrial pacing frequency on interatrial conduction time were analyzed. The occurrence of atrial fibrillation was compared within an average one year follow-up period. Results ①There were no differences in basic information before treatment between the two groups. ②There were no complication, pacing and sensing dysfunction between the two groups.③The occurrence of atrial fibrillation in low atrial septal group was lower than that in right atrial appendage pacing group. Similarly, the conduction time from P wave to left atrial was shorter and left atrioventricular conduction time was longer in low atrial septal group. The difference was statistically significant.④ Left atrioventricular interval was longer in high pacing frequency（80 bpm） compared to low pacing frequency（60 bpm） between the two groups. The difference was statistically significant. Conclusion In sick sinus syndrome patients, the occurrence of atrial fibrillation is lower on lower atrial septal group. Increasing atrial pacing percentage may be enhanced the effect. The mechanism may be associated with shortened interatrial conduction and extended left atrioventricular interval, which improves interatrial and left atrioventricular synchrony eventually.

关 键 词：病态窦房结综合征 房颤 房间隔起搏 右心耳起搏 起搏频率 

分 类 号：R541.74[医药卫生—心血管疾病] R541.75[医药卫生—内科学]