心室起搏心律不适患者的起搏器参数优化  

Optimaization the parameters of pacemaker in patients who were uncomfortable because of ventricular pacing

作　　者：王三娣[1] 李继文[1] 韩宏伟[1] 李振[1] 蒋萍[1] 闻捷[1] 

机构地区：[1]武汉亚洲心脏病医院心电生理室,430022

出　　处：《临床心电学杂志》2016年第4期262-264,共3页Journal of Clinical Electrocardiology

摘　　要：目的 通过对起搏器参数的优化,尽可能减少心室起搏,提高患者生活质量.方法 2005年1月～2013年10月在我院病态窦房结综合征（SSS）患者植入双腔起搏器后心室起搏时诉胸闷、心悸不适,82例患者,设置最长的房室间期（AVD）,延长心室后心房不应期（PVARP）至450ms,关闭心室自动阈值夺获功能,如仍有不适症状,通过起搏器程控仪较长时间监测或Holter等检查方法查找发生心室起搏的原因,并进行相应的处理.结果 62例病人症状消失,仍有20例有不适症状.导致心室起搏的原因及处理方法如下：①2例活动后因起搏器频率适应性功能致心房起搏频率增加后,出现二度Ⅰ型房室阻滞,关闭频率适应性起搏功能后症状缓解;②2例因心房误感知设置较高的感知灵敏度后心室起搏消失;③2例提高心房起搏电压,1例重新植入心房电极,解决了心房失夺获从而避免了心室起搏;④5例阵发性房速/房扑患者缩短心室后心房空白期,使模式转换能发生,3例心房率较慢的房速患者设置为DDI模式,5例房颤患者降低下限频率,减少了心室起搏.结论 心室起搏心律不适患者设置较长的AV间期,设置PVARP 450ms,关闭心室自动阈值夺获功能,如仍有不适症状,通过起搏器程控仪进行较长时间的心电监护或动态心电图检查找出导致心室起搏的原因,并对起搏器相关参数进行设置,能有效减少或消除心室起搏.Objective In order to minimize ventricular pacing and improve the life quality, we optimaization the parameters of pacemaker in patients. Methods We chose 82 patients who were implanted dual-chamber pacemaker because of SSS during January 2005 to october 2013. They obviously felt chest tightness and palpitations when ventricular pacing. We set the maximum Arial Ventricular Delay （AVD）, prolonged PVARP to 450ms and turned off Ventricular Capture Management （VCM）. If they still had symptoms, we looked for the causes of ventricular pacing by monitoring with programmer or Hoher, and treated the condition according to different cases. Results 62 patients＇ symptoms were disappeared, and other 20 patients still had symptoms. The causes of ventricular pacing and treatment methods are as follows. ①Two patients showed up increases of atrial pacing frequency caused by rate response function after exercise, which resulted in II° I AVB and ventricular pacing. We closed rate response function and the symptoms were reduced; ② Two patients caused by atrial over-sensing, and the symptoms disappeared when we set a higher atrial sensitivity; ③Two patients were increased atrial output voltage and one patient was replaneted atrial electrode with loss of atrial capture and ventricular pacing; ④Five patients with paroxysmal atrial tachycardia / atrial flutter were shortened PVAB to make mode swich. Three atrial tachycardia patients were set as DDI, and other five patients with atrial fibrillation were let the low rate down to reduce ventricular pacing. Conclusions Some patients who are uncomfortable because of ventricular pacing we set a longer AVD, prolonged the PvARP to 450ms, and turn off VCM. If nothing changes, we look for the causes of ventricular pacing by monitoring with pacemaker programmer or Holter, and adjust relevant parameters which can reduce or terminate ventricular pacing.

关 键 词：心室起搏心律 AV间期 PVARP 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]