心房起搏不良导致PMT反复发作1例  

A case of recurrent PMT caused by poor atrial pacing

作　　者：陈健 CHEN Jian(Xinhua Hospital Affiliated to School of Medicine of Shanghai Jiaotong University,Shanghai 202150,China)

机构地区：[1]上海交通大学医学院附属新华医院崇明分院心电图室,上海202150

出　　处：《海南医学院学报》2020年第11期868-870,875,共4页Journal of Hainan Medical University

摘　　要：植入DDD起搏器的患者可发生起搏器介导性心动过速(PMT),而狭义的PMT是一种环形运动性心动过速,常由室房逆传所致。本文报道1例病人在起搏器植入早期出现心房起搏阈值增高导致心房起搏不良,从而诱发室房逆传及PMT反复发作,几乎呈无休止性。虽然起搏器具有PMT自动终止程序,但由于心房起搏不良的存在,PMT依然呈短阵反复发作,导致患者出现气急、下肢水肿等心衰症状。最终通过延长PVARP使PMT不再发生,并将其下限起搏频率减慢至50 BPM,而且AV间期保持250 ms不变,以减少心房脉冲的发放并鼓励自身窦性下传激动的出现,心房及心室起搏比例明显减少,这样既节省了起搏器电能又符合生理性。Pacemaker mediated tachycardia(PMT)can occur in patients with DDD pacemaker implantation,and PMT,in narrow sense,is a kind of circular motor tachycardia,which is often caused by ventricular atrial retrograde conduction.This paper reports a case of patients with high atrial pacing value in the early stage of pacemaker implantation,resulting in atrial retrograde conduction and recurrent PMT of almost non-stop.Although the pacemaker has the PMT automatic termination procedure,PMT is still a short array of repeated attacks due to the presence of poor atrial pacing,resulting in the patients with shortness of breath,lower extremity edema and other heart failure symptoms.Finally,PMT was stopped by prolonging PVARP,and its lower starting frequency was slowed down to 50 bpm,and AV interval was kept unchanged for 250 ms,so as to reduce the release of atrial pulse and encourage the emergence of self selling down-propagation excitation.The proportion of atrial and ventricular pacing was significantly reduced,which not only saved the electric energy of pacemaker,but also conformed to the physiology.

关 键 词：心房起搏不良 室房逆传 起搏器介导性心动过速 

分 类 号：R541.7[医药卫生—心血管疾病]