无导线起搏器Micra AV植入患者房室同步效果观察分析  

Observation and analysis of atrioventricular synchrony in patients implanted with leadless pacemaker Micra AV

作　　者：王佳 邹彤 Wang Jia;Zou Tong(Peking University Fifth School of Clinical Medicine,Beijing 100730,China;Department of Cardiology,National Center of Gerontology,Institute of Geriatric Medicine,Beijing Hospital,Peking University Fifth School of Clinical Medicine,Beijing 100730,China)

机构地区：[1]北京大学第五临床医学院,北京100730 [2]北京大学第五临床医学院,北京医院心血管内科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730

出　　处：《中国医学前沿杂志（电子版）》2023年第12期57-63,共7页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：美敦力产品监测登记平台临床研究;心脏节律与心衰疾病管理-中国人群Micra AV短期性能研究。

摘　　要：目的 观察Micra AV植入后实际房室同步(atrioventricular synchronization,AVS)效果。方法 采用回顾性队列研究方法。选取2022年8月至2023年4月在北京医院连续植入VDD型无导线起搏器的12例患者,通过电子病历系统收集一般临床资料,进行6个月起搏器相关电学参数门诊随访观察,分析各患者AVS比例特征。针对AVS比例低的患者,复查Holter并结合起搏器内置数据探究AVS比例低的原因,进行程控管理。结果 最终入选患者12例,中位初始AVS比例为74.3%。完全三度或高度房室传导阻滞、相对高A4阈值、心室率50~80次/min的患者(4例)AVS生理性起搏比例高(84.1%~87.0%),房室传导阻滞比例低、窦房结功能障碍、节段性室壁运动异常、左心房增大的患者(4例)AVS比例降低(66.0%~76.6%),合并房性早搏、窦性心动过速、阵发性心房颤动患者(4例)AVS比例大幅降低(27.8%~50.1%),使用Holter监测仪对程控优化AVS具有一定的指导意义。结论 窦房结功能正常伴三度或高度房室传导阻滞、相对高A4阈值、心室率50~80次/min的患者更易实现AVS生理性起搏。Holter监测作为辅助工具,为优化起搏器工作参数提供更加全面可靠的客观依据。Objective To observe the actual atrioventricular synchrony after Micra AV implantation.Methods In retrospective cohort study,12 consecutive patients who were implanted with VDD leadless pacemakers in Beijing Hospital from August 2022 to April 2023 were included.General clinical data were collected through the electronic medical record system,and the electrical parameters related to pacemakers were observed in the outpatient follow-up for 6 months.The percentage of atrioventricular synchrony in each patient were analyzed.For patients with low atrioventricular synchrony,Holter was re-examined and the reasons for low atrioventricular synchrony were explored in combination with the built-in data of pacemaker,and programmed management was carried out.Results Twelve patients were enrolled,and the median initial AVS was 74.3%.Patients with complete third degree or high atrioventricular block,relatively high A4 threshold,and ventricular rate of 50-80 beats/min(4 cases)had a higher rate of physiologic pacing of AVS(84.1%-87.0%).The percentage of AVS decreased(66.0%-76.6%)in patients with low atrioventricular block,sinus node dysfunction,segmental wall motion abnormality,and left atrial enlargement(4 cases),and the percentage of AVS decreased significantly(27.8%-50.1%)in patients with atrial premature beat,sinus tachycardia,and paroxysmal atrial fibrillation(4 cases).The use of Holter monitor has certain guiding significance for optimal interrogation of AVS.Conclusions Patients with normal sinus node function,third degree or high atrioventricular block,relatively high A4 threshold,and ventricular rate of 50-80 beats/min are more likely to achieve physiological pacing of AVS.As an auxiliary tool,Holter monitoring provides a more comprehensive and reliable source for optimal device interrogation.

关 键 词：Micra AV 无导线起搏器 生理性起搏 房室同步 

分 类 号：R541.7[医药卫生—心血管疾病]