我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

窦房结功能不良与传导阻滞患者植入双腔起搏器后动态心电图的表现及其意义

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2018年第5期
页码:
538-541
栏目:
临床研究
出版日期:
2018-06-25

文章信息/Info

Title:
Manifestation and significance of dynamic electrocardiogram after dual chamber pacemaker implantation in patients with sinus node dysfunction or conduction block
作者:
李 彦
(邯郸市中心医院心内科一病区，河北 邯郸 056000)
Author(s):
LI Yan
(First Department of Cardiology, Handan Central Hospital, Handan 056000, Hebei, China)
关键词:
动态心电图; 起搏器; 窦房结功能不良; 传导阻滞
Keywords:
dynamic electrocardiogram;  pacemaker;  sinus node dysfunction;  conduction block
分类号:
R541.7
DOI:
-
文献标识码:
A
摘要:
目的 探讨窦房结功能不良与传导阻滞患者植入双腔起搏器后动态心电图的表现及临床意义。方法 分析植入DDD型双腔起搏器的160例患者的动态心电图，其中窦房结功能不良组80例，传导阻滞组80例，比较2组患者植入双腔起搏器后的动态心电图表现、主要的工作模式、心室起搏情况、自身心律失常及起搏器所致的心律失常。结果 窦房结功能不良组与传导阻滞组起搏比例≥60%者均多于起搏比例<60%者（82%比18%、85%比15%），组间差异无统计学意义。窦房结功能不良组心房按需起搏工作模式显著高于传导阻滞组（31%比2%，P<0.01），而心室按需起搏/心房同步心室起搏工作模式显著低于传导阻滞组(19%比50%，P<0.01)；组间比较，双腔按需起搏工作模式检出率二者无统计学差异（50%比48%）。窦房结功能不良组心室安全起搏检出率显著高于传导阻滞组(25%比12%，P<0.05），而心室起搏融合波的检出率则显著低于传导阻滞组(35%比51%，P<0.05)。窦房结功能不良组起搏介导性心动过速及感知房性心动过速触发快速型心室起搏的检出率显著高于传导阻滞组（12%比2%，24%比11%，P<0.05)，房性心动过速和频发房性早搏的检出率亦显著高于传导阻滞组（38%比18%，22%比4%，均P<0.05）。结论 窦房结功能不良与传导阻滞患者植入双腔起搏器后对应的主要工作模式可以通过动态心电图的各种表现进行识别，全面了解起搏器的工作状态，为起搏器的合理程控以及自身心律失常提供可靠的依据。
Abstract:
AIM To discuss the manifestation and significance of dynamic electrocardiogram (DCG) after dual chamber pacemaker was implanted in patients with sinus node dysfunction or conduction block. METHODS DCG was analyzed in 160 patients who had been implanted with DDD-type dual chamber pacemaker. The patients were divided into sinus node dysfunction group (n=80) and conduction block group (n=80). The manifestation of DCG, the main work pattern, chamber pace-making condition, autologous arrhythmia as well as the arrhythmia caused by pacemaker were compared between the two groups. RESULTS The pace making proportion of ≥60% in both sinus node dysfunction group and conduction block group was significantly higher than that of <60% (82% vs. 18%; 85% vs. 15%), with no significant difference between the two groups. The demand pacing mode in sinus node dysfunction group was higher than that in conduction block group (31% vs. 2%, P<0.01), while the chamber demand pacing mode/atrium demand pacing mode in sinus node dysfunction group was significantly lower than that in conduction block group (19% vs. 50%, P<0.01). The comparison of dual chamber demand pacing mode between the two groups showed no statistical significance (50% vs. 48%). The chamber pacing safety detectable rate in sinus node dysfunction group was significantly higher than that in conduction block group (25% vs. 12%, P<0.05), while the pacemaker fusion wave detectable rate in sinus node dysfunction group was significantly lower than that in conduction block group (35% vs. 51%, P<0.05). The detectable rate of chamber pacemaker-mediated tachycardia and perceptional tachycardia in sinus node dysfunction group was significantly higher than that in conduction block group (12% vs. 2%, 24% vs. 11%, P<0.05). The detectable rate of chamber tachycardia and frequent atrial premature beats in sinus node dysfunction group was also significantly higher than that in conduction block group (38% vs. 18%, 22% vs. 4%, both P<0.05). CONCLUSION After dual chamber pacemaker implantation, the corresponding work mode can be recognized by the manifestation of DCG in sinus node dysfunction patients and conduction block patients. Full knowledge of the pacemaker work mode will be good for reasonable control of the implanted pacemaker and autologous arrhythmia.

参考文献/References

[1]陆 敏.希氏束起搏的临床研究进展[J].国际心血管病杂志,2016,43(3):158-160.

[2]《中国心脏起搏与心电生理杂志》编辑部,中国生物医学工程学会心脏起搏与电生理分会.埋置心脏起搏器及抗心律失常器指南[J].中国心脏起搏与心电生理杂志,2003,17(5):321-337.

[3]乔 清，徐 伟.ACCF/AHA/HRS植入器械指南中普通起搏器植入适应症解读[J].中国介入心脏病学杂志,2014,22(9):611-612.

[4]郭 飞.起搏器介导的房室阻滞[J].临床心电学杂志,2014,23(1):76.

[5]柳 琼.常规12导心电图与24h动态心电图对起搏器植入术后患者心律失常的诊断比较[J].安徽医药,2015,36(8):938-939.

[6]Sinha SK,Kumar P,Singhal G,et al.Challenges in lead position and stability of single entry through cephalic route by sheathless technique in dual chamber pacemaker implantation[J].J Indian Coll Cardiol,2017,7(2):85-87.

[7]Uehara Y,Yoshida K,Kimata A,et al.Underrecognized entity of the transient rise in the atrial capture threshold early after dual-chamber pacemaker implantation[J].Pacing Clin Electrophysiol,2017,40(12):1396-1404.

[8]冯杰莉,张 媛,李昭屏.双腔起搏器植入后不同右心室心尖部起搏比例对心脏结构功能的远期影响[J].北京大学学报(医学版),2014,46(6):879-882.

[9]李 波，韩 雪，纳志英，等.DDD起搏器植入后不同患者的动态心电图的表现及其临床意义[J].昆明医科大学学报,2014,35(10):143-147.

[10]欧阳征鹏，李赵欢，李 霞.不同类型起搏器术后动态心电图的临床应用价值[J].重庆医学,2015,12(36):5082-5086.

[11]李永东,葛智平,温慧华,等.具有自动搜索心房滞后功能的起搏器对房性心律失常近期影响研究[J].中华临床医师杂志:电子版,2013,7(6):2343-2345.

[12]周建龙,朱宗成,朱天哲,等.不同起搏模式及右室起搏比例不同对缓慢型心律失常患者心功能及新发房颤影响的随访分析[J].齐齐哈尔医学院学报,2014,35(20):2975-2977.

[13]Rai MK,Prabhu MA,Sharma A,et al.‘Optimized’ LV only pacing using a dual chamber pacemaker as a cost effective alternative to CRT[J].Indian Pacing Electrophysiol J,2017,17(3):72-77.

[14]张雪梅,冯 晶,汤喜红.传导阻滞与窦房结功能不良患者双腔起搏器植入后动态心电图的表现及其意义[J].中国医药,2016,11(1):22-25.

[15]王勇，刘国兵.永久心脏起搏器植入术后并发症发生原因及处理[J].心血管康复医学杂志,2011,20(2):163-164.

[16]Calvi V,Pisanò EC,Brieda M,et al.Atrioventricular Interval Extension Is Highly Efficient in Preventing Unnecessary Right Ventricular Pacing in Sinus Node Disease:A Randomized Cross-Over Study Versus Dual-to Atrial Single-Chamber Mode Switch[J].JACC Clin Electrophysiol,2017,3(5):482-490.

[17]姚 静，许 迪，唐 欢，等.病态窦房结综合征患者DDD起搏器植入术后房室顺序下传及右室心尖部起搏模式下左心室舒张功能评估[J].中华超声影像学杂志,2016,25(3):185-191.

[18]邹 强,杨 媚,单迎光,等.重编程心脏传导系统:向生物起搏器进军[J].疑难病杂志,2016,15(9):881-884.

[19]郭继鸿.功能性感知不良与临床[J].临床心电学杂志,2012,21(5):383-392.

[20]王 玮，何朝荣，党书毅，等.室上性心动过速启动的VVI起搏器非同步模式转换一例[J].中国心脏起搏与心电生理杂志,2006,20(3):278-279.

[21]何方田，尹小妹.DDD起搏器以DDD、AAI模式起搏及开启A-V间期滞后搜索功能或具备心室起搏管理功能[J].心电学杂志,2011,30(3):268-269.

备注/Memo

备注/Memo:
收稿日期：2018-01-03.基金项目：邯郸市科学技术研究与发展计划项目资助（1523108077-7） 作者简介：李彦，副主任医师，硕士 Email：liyanhbhandan@163.com
更新日期/Last Update: 1900-01-01