刺激性房性心律失常在永久性起搏器心房起搏电极放置过程中的作用观察

摘要

Objective To investigate the role of the stimulated atrial arrhythmias during atrial lead implantation. Methods DDD/DDDR pacing was performed in 58 patients were divided into low morhidity ( Croup A) and high morbidity ( Group B) .Success rate of the procedures were compared between the two groups. Then 84 patients were divided into 42 patients ( Group C) paced effectively by X-ray-mediated way and tested pacing parameter using regular observation methods while 56 patients ( Group D) paced effectively hy X-ray-mediated way to find the possible right auricle and frequent stimulated atrial arrhythmias or atrial tachycardia and tested pacing parameter. We compared X-ray exposure time and operation time when reachding nice pacing parameters between the two different groups. Results Incidence of stimulated atrial arrhythmias in Group D was 100％ , atrial tachycardia allways happened when reached right auricle,The success rate of the procedures in group D were 100％ , which were significantly higher than that in controls( Group C) ( P ＜ 0. 01) . X-ray exposure time and operation time reached nice pacing parameters in Group D was significantly shorter than that in Group C( P ＜ 0. 01) . Conclusion Right auricle was an ideal implantation location. The number of the stimulated atrial arrhythmias were reference indicators for implantation of atrial lead.%目的 观察刺激性房性心律失常在永久性起搏器心房起搏电极放置过程中的作用.方法 先将58例DDD/DDDR手术患者,分为A组(少发房性心律失常组)和B组(多发房性心律失常组).观察两组达满意心房起搏参数的成功率.再根据不同观察方法分为:C组(常规对照组):共42例患者,采用X线影像学方法到位,然后测试起搏参数;D组(观察组):共56例患者,采用在X线影像学指导下找到可能的右心耳且出现较多的刺激性房早或者短阵房速处为起搏部位,再行起搏参数测定.观察两组达满意心房起搏参数的X线曝光时间和手术时间.结果 B组100%出现刺激性房性心律失常,特别是电极刖入右心耳时一般会出现短阵房速,其达满意心房起搏参数值例次数达100%,与A组比较差异有统计学意义.D组右心房电极到位的X线曝光时间和手术时间明显短于C组,两组比较差异有统计学意义.结论 右心耳是理想的右心房电极植入点.刺激性房性心律失常的多少可以作为安植永久性起搏器右心房电极到住时的一个参考指标.