病态窦房结综合征患者不同心房起搏部位及频率对术后房颤发生的影响  

Effects of different atrial pacing sites and frequencies on atrial fibrillation in patients with sick sinus syndrome

作　　者：毛明洁 王巧凤 李红梅[1] 袁森[1] 张院[1] MAO Ming-jie;WANG Qiao-feng;LI Hong-mei;YUAN Sen;ZHANG Yuan(First Department of Cardiovascular Medicine,North Hospital of Xi'an,Xi'an 710043,Shaanxi,CHINA)

机构地区：[1]西安市北方医院心血管内一科

出　　处：《海南医学》2020年第2期157-159,共3页Hainan Medical Journal

摘　　要：目的分析病态窦房结综合征(SSS)患者不同心房起搏部位及频率对术后房颤发生的影响。方法选取西安市北方医院心血管内一科2017年12月至2018年12月收治的90例SSS患者为研究对象,按照随机数表法将其分为观察组和对照组,每组45例。对照组患者将心房电极植入右心耳,观察组将心房电极植入低位房间隔。随访6个月,比较两组患者不同频率的心房起搏下,P波到左房的传导时间和左侧房室的间期,对比不同起搏部位对术后发生房颤的影响。结果两组患者在治疗期间均未发生起搏和感知功能障碍情况;观察组与对照组患者房颤发生率(0 vs 15.6%)、60 bpm、70 bpm及80 bpm P波到左房的传导时间[(46.2±11.3)ms、(42.1±12.7)ms、(44.1±17.3)ms vs(101.1±26.4)ms、(105.8±13.8)ms、(115.3±13.4)ms]、60 bpm、70 bpm及80 bpm左侧房室间期[(126.3±26.1)、(131.1±28.5)、(150.2±31.6)ms vs(108.2±29.4)ms、(111.3±24.4)ms、(125.1±21.2)ms]比较差异均有统计学意义(P<0.05),而与低起搏频率比较,高起搏频率能够明显延长左侧房室间期,差异具有统计学意义(P<0.05)。结论低位房间隔起搏时,SSS患者房颤的发生率更低,在临床中可适当提高心房起搏频率,降低房颤发生率。Objective To analyze the effect of different atrial pacing sites and frequencies on the occurrence of atrial fibrillation in patients with sick sinus syndrome. Methods Ninety patients with sick sinus syndrome admitted to the First Department of Cardiology, North Hospital of Xi’an from December 2017 to December 2018 were selected as the research objects. The patients were divided into the observation group and control group according to random number table method, with 45 cases in each group. The patients in the control group were implanted with atrial electrodes in the right atrial ear, while those in the observation group were implanted with atrial electrodes in the low atrial septum.After 6 months follow-up, the transmission time of P wave to left atrium and the interval between left atrium and ventricle were compared between the two groups under different frequencies of atrial pacing, and the effect of different pacing sites on the occurrence of atrial fibrillation after operation was compared. Results Pacing and sensory dysfunction did not occur in both groups during treatment. There were significant differences in the incidence of atrial fibrillation(0 vs 15.6%), the transmission time of 60 bpm, 70 bpm and 80 bpm P wave to left atrium with(46.2±11.3) ms,(42.1±12.7) ms,(44.1±17.3) ms vs(101.1±26.4) ms,(105.8±13.8) ms,(115.3±13.4) ms, and the 60 bpm, 70 bpm,80 bpm interval between left atrium with(126.3 ± 26.1) ms,(131.1 ± 28.5) ms,(150.2 ± 31.6) ms vs(108.2 ± 29.4) ms,(111.3±24.4) ms,(125.1±21.2) ms between the observation group and the control group(all P<0.05). Compared with low pacing frequency, high pacing frequency could prolong the interval between left atrium and ventricle more significantly(P<0.05). Conclusion The incidence of atrial fibrillation in patients with sick sinus syndrome is lower when atrial septal pacing is performed. The frequency of atrial pacing can be increased, and the incidence of atrial fibrillation can be reduced in clinic.

关 键 词：病态窦房结综合征 心房起搏 房颤 房室传导 低位房间隔 心律失常 

分 类 号：R541.75[医药卫生—心血管疾病]