双房同步起搏临床应用中的若干重要问题探讨  

Considerations for Clinical Application of Biatrial Synchronous Pacing.

作　　者：宋冠英[1] 顾晓葵[1] 

机构地区：[1]上海市胸科医院心内科,上海200030

出　　处：《中国心脏起搏与心电生理杂志》2001年第6期371-374,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：双房同步起搏治疗病窦综合征伴房间传导阻滞导致的阵发性心房颤动 (简称房颤 )已应用于临床。通过对 6例安置双房同步起搏器病人术前及术后 1～ 2年的随访来探讨实际应用中若干需要重视的问题。结果 :①术前P波时限和离散度分别在 110～ 15 0ms和 10～ 5 0ms之间 ,双房同步起搏后则分别为 80～ 12 0ms和 10～ 30ms。② 1例房颤发作消失、3例控制、2例无效。③冠状窦电极脱位 3例。结论 :①严格掌握双房同步起搏的指征是确保疗效的关键 ,P波时限和离散度同时延长且延长越多 ,越适于双房同步起搏。②程控为双极AAT模式才能真正实现双房同步 ,合并房室阻滞的病人应选用具有DDTA功能的起搏器。③双房同步起搏体表心电图表现为P波时限短、负向或正负双向 ,PR间期相应缩短。④Medtronic 5 86 6 38M型适配器串联连接双房电极 ,心房电极总阻抗是右房和冠状窦电极阻抗之和 ,不应误认为电极脱位 ,需相应提高起搏电压以维持有效起搏。⑤冠状窦专用电极头端两个弯度必须均进入窦内 ,以深处为佳 ,导管缝扎固定须谨慎。Biatrial synchronous pacing is used to cure sick sinus syndrome patients with paroxysmal atrial fibrillation(AF) due to inter atrial conduction blocking.We intended to emphasize some questions of the clinical application of biatrial pacing.We studied six patients who were implanted biatrial pacemakers in our hospital.Results:①P wave duration and dispersion were 110～150 ms and 10～50 ms before operations,80～120 ms and 10～30 ms when biatrial synchronic pacing.②One patient was free of AF recurrence.Three were suppressed and the other two were ineffective.③The coronary sinus electrodes were migrated in three patients.Conclusions:①Strictly controlling the indication of biatrial pacing is most important to have an effective outcome.P wave duration and dispersion should prolong simultaneously,the more,the fitter.②Programme mode should be Bipolar AAT because it truly makes biatrial synchrony.③The surface body electrocardiogram(ECG) manifestations of biatrial pacing are that P wave duration shortens,the polarity of P wave changes to negative,PR interval gets shorter correspondingly.④Medtronic 5866 38M adaptor connects the atrial two lead in cascade circuit.Total atrial impedence is the sum of the impedance of the right atrial electrode and the coronary sinus(CS)electrode.So the pacing voltage should rise correspondingly.⑤Making sure that the two curvatrues of the CS electrode tip are completely placed into the sinus is important to prevent migration,the deeper,the better.Stabilization of the electrode catheter is also very improtant.

关 键 词：双房起搏 房间传导阻滞 房内传导阻滞 P波离散度 起搏电极配置 

分 类 号：R541.705[医药卫生—心血管疾病] R318.11[医药卫生—内科学]