论文标题:起搏治疗对心房颤动的影响
Influence of Pacing Therapy on the Incidence of Atrial Fibrillation
论文作者
论文导师 蒋廷波,论文学位 硕士,论文专业 心血管内科学
论文单位 苏州大学,点击次数 79,论文页数 45页File Size1341K
2007-05-01论文网 http://www.lw23.com/lunwen_287037612/
Pacing mode;; Sick sinus syndrome;; Atrial fibrillation;; Cardiac function;; Pacing algorithms;; Atrial fibrillation burden
第一部分:AAI和DDD起搏对病态窦房结综合征患者心房颤动的影响 目的:比较AAI与DDD起搏方式对有正常房室传导功能的病态窦房结综合征(病窦综合征)患者预后的长期影响,包括心房颤动(房颤)的发生率,心功能和心脏大小。 方法:选择我院1999年1月至2005年12月因病窦综合征植入起搏器的患者,按心脏起搏器不同起搏方式分为两组:AAI组45例,DDD组88例。分别于植入后1个月,3个月,6个月,以后每年一次进行随访,随访内容包括患者的症状,体征,心电图和/或动态心电图,超声心动图,心功能分级及起搏器检查。主要研究终点为房颤的发生率,次要终点为心功能分级及超声心动图检查指标(左心房内径、左心室舒张末期内径、左心室射血分数)。 结果:平均随访时间12～85(32.4±15.2)个月。(1)AAI组房颤发生率明显低于DDD组( 11.1%vs 27.3%, P < 0.05)。(2)至随访结束时,AAI组左心房内径、左心室舒张末期内径和左心室射血分数与植入前比较差异均无统计学意义(P>0.05);DDD组左心房内径、左心室舒张末期内径与植入前相比均明显增大,左心室射血分数明显减低,差异均有统计学意义(P<0.05); DDD组与AAI组相比,左心房内径、左心室舒张末期内径较大,左心室射血分数较低,差异均有统计学意义(P<0.05)。(3) AAI组与DDD组比较,对心功能影响较小。 结论:对于房室传导功能正常的病窦综合征患者,AAI起搏方式与DDD比较,房颤发生率明显降低,对心功能影响较小,更符合生理性。 第二部分:特殊心房起搏程序预防和治疗阵发性心房颤动的临床效果 目的:评价特殊心房起搏程序预防和治疗阵发性房颤的临床效果。 方法:我院自2002年4月至2005年12月对12例病态窦房结综合征合并阵发性房颤患者植入Vitatron Selection 900E (AF2.0、DDDR)型双腔起搏器,植入方法同普通的双腔起搏器。术后每月进行随访,观察比较患者术后不同阶段阵发性房颤的发作总数,持续时间,房颤负荷和心房起搏比率。 结果:除1例患者外,其余11例患者术后第2个月和第6个月(起搏预防阶段)比术后第1个月(监测阶段)的阵发性房颤事件数[80(25;215),57(12;102) vs203(86;425)],房颤总持续时间[1.9d(0.6d;5.3d),1.5d(0.3d;6.1d) vs2.9d(0.8d;9.8d)],房颤负荷[6.3%(2.0%;17.7%),5.0%(1.0%;20.6%)vs9.6%(2.7%;32.8% )]均减低(P均<0.05),心房起搏比率[60%(40%;80%), 54%(42%;84%)vs 46%(26%;54%)]增加(P<0.05)。 结论:预防性心房起搏程序可以减少阵发性房颤事件的发生,降低房颤负荷,改善患者的症状,具有短期的疗效。
Part One: Influence of different pacing modalities on the incidence of atrial fibrillation in patients with sick sinus syndrome Objective: A randomized trial was done to compare the influence of single- chamber atrial (AAI) and dual-chamber (DDD) pacing in patients with sick sinus syndrome ( SSS) and normal atrioventricular(AV)conduction, including the incidence of atrial fibrillation, changes of cardiac function and cardiac size. Methods: Patients with SSS who were implanted with pacemakers from January 1999 to December 2005 were enrolled. A Total of 133 consecutive patients were randomized to treatment with one of modes of pacemaker:AAI (n=45) or DDD (n=88).Patients were followed up after one month , three months, six months, and then once a year.The follow-up visits included patients’symptoms, physical examination, electrocardiogram (ECG) recording/or Holter recording ,echocardiography, New York Heart Association (NYHA) cardiac function class and pacemaker check-up.The primary end point was the incidence of atrial fibrillation. The second end points were New York Heart Association(NYHA) cardiac function class, changes in left atrial(LA) and left ventricular end-diastolic(LVED)diameters, as well as left ventricular ejection fraction (LVEF)measured by echocardiography. Result: Mean follow-up was 12～85(32.4±15.2) months.(1)Atrial fibrillation was significantly less common in the AAI group than in DDD group (11.1% vs 27.3%, P < 0.05). (2)In the AAI group, no significant changes were observed in LA diameter or LVED diameter or LVEF from baseline to last follow-up(P>0.05);In the DDD group,LA diameter and LVED diameter increased significantly(P<0.05), and LVEF decreased significantly from baseline to last follow-up (P<0.05);There was statistical difference in these values between AAI and DDD group (P<0.05) at last follow-up. (3)Compared with DDD group, AAI group have less effect on cardiac function. Conclusion: In patients with sick sinus syndrome and normal atrioventricular conduction, AAI pacing mode is more physiological than DDD pacing mode,with less incidence of atrial fibrillation and accepted cardiac function. Part Two: The clinical effect of atrial pacing algorithms on prevention and treatment of paroxysmal atrial fibrillation Objective: To evaluate the clinical effect of atrial pacing algorithms on prevention and treatment of paroxysmal atrial fibrillation (PAF). Methods: Twelve patients with sick sinus syndrome and paroxysmal atrial fibrillation were implanted with Vitatron Selection 900E(AF2.0、DDDR) pacemaker, the method of implantation is as same as the general double chamber pacemakers.After implantation patients were followed up every month to compare the numbers of PAF episodes stored, AF total duration, AF burden and atrial pacing rate in the monitoring phase and preventive pacing phase. Result: Except for one patient, the median number of PAF episodes stored [80(25;215),57(12;102)vs203(86;425)], the median AF total duration [1.9d(0.6d;5.3d), 1.5d(0.3d;6.1d)vs2.9d(0.8d;9.8d)]and the median AF burden [6.3%(2.0%;17.7%), 5.0% (1.0%;20.6%)vs9.6%(2.7%;32.8% )]of other patients were significantly decreased in the second month and the sixth month after implantation (preventive pacing phase) compared with those in the first month after implantation(monitoring phase) (P all<0.05), atrial pacing rate [60%(40%;80%), 54%(42%;84%)vs46%(26%;54%)]was significantly increased (P<0.05). Conclusion: Atrial-based preventive algorithms can decrease the number of PAF episodes and AF burden, as well as reduce symptoms.It has short-term therapeutic effect.
|
