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

李彦

doi:10.13191/j.chj.2018.0129

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

李彦

Manifestation and significance of dynamic electrocardiogram after dual chamber pacemaker implantation in patients with sinus node dysfunction or conduction block

LI Yan

摘要

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.

HTML全文

参考文献(0)

施引文献

资源附件(0)