【摘要】 目的:观察心室起搏管理(managed ventricular pacing,MVP)对病态窦房结综合征(sick sinus syndrome,SSS)患者心功能的影响。方法:42例植入具有MVP功能的双腔起搏器(Medtronic Adapta ADD01/ADDR01/ADDRL1)的SSS患者,先以双腔起搏(DDD/R)模式工作6个月,再程控为MVP模式工作6个月,统计两种模式下右心室起搏比例,并比较两种模式下患者心功能的变化。结果:在DDD/R模式下,平均右心室心尖部起搏比例达43.6%,左心室射血分数(left ventricular ejection fraction,LVEF)从(56.5±2.6)%下降至(54.1±3.0)%(P=0.001),左心室舒张末期直径(left ventricular end-diastolic diameter,LVEDD)从(49.6±2.6)mm升高至(51.4±2.4)mm(P=0.002),B型利钠肽(B-type natriuretic peptide,BNP)从(77.0±16.2)pg/mL升高至(87.2±16.4)pg/mL(P=0.032)。在MVP模式下,平均右心室心尖部起搏比例仅为1.8%,LVEF从(54.1±3.0)%上升至(55.4±1.4)%(P=0.042),LVEDD从(51.4±2.4)mm下降至(50.2±2.0)mm(P=0.016),BNP从(87.2±16.4)pg/mL下降至(86.5±14.9)pg/mL(P=0.852)。另外,DDD/R模式下有4例患者发生阵发性心房颤动,而MVP模式下仅1例发生阵发性心房颤动,但差异无统计学意义(P=0.180)。结论:与DDD/R模式比较,MVP模式能显著减少右心室起搏比例,且对心功能有较好的保护作用。更多还原

【Abstract】 Objective:To study the effect of managed ventricular pacing(MVP)on heart function in patients with sick sinus syndrome(SSS).Methods:Pacemakers with MVP algorithm were implanted in 42 patients with SSS.Conventional DDD/R mode had been programmed in the first 6 months,and then MVP algorithm had been programmed in the next 6 months.Right ventricular pacing proportions were calculated,and the heart function changes were compared between the two modes during 6-month follow-up.Results:During DDD/R mode,the mean value of cumulative right ventricular pacing proportion was 43.6%; left ventricular ejection fraction(LVEF)decreased from(56.5±2.6)% to(54.1±3.0)%(P=0.001);left ventricular enddiastolic diameter(LVEDD)increased from(49.6±2.6)mm to(51.4±2.4)mm(P=0.002);B-type natriuretic peptide(BNP) increased from(77.0±16.2)pg/mL to(87.2±16.4)pg/mL(P=0.032).During MVP algorithm,the mean value of cumulative right ventricular pacing proportion was 1.8%;LVEF increased from(54.1±3.0)% to(55.4±1.4)%(P=0.042); LVEDD decreased from(51.4±2.4)mm to(50.2±2.0)mm(P=0.016);BNP decreased from(87.2±16.4)pg/mL to(86.5 ±14.9)pg/mL(P=0.852).In addition,paroxysmal atrial fibrillation was found in 4 cases in the DDD/R mode,and 1 case in the MVP algorithm(P=0.180).Conclusions:Compared with conventional DDD/R mode,MVP algorithm significantly reduces the cumulative right ventricular pacing proportion,and it can protect heart function better.更多还原