摘要
探索心房起搏比率对病态窦房结综合征（病窦综合征,SSS）患者起搏器术后心房颤动发生的影响。方法：选取2012年9月至2014年3月,因SSS于我院住院首次植入双腔起搏器,且术前无心房颤动病史的患者171例。术后1个月、3个月、6个月和1年分别进行程控随访获取心房起搏比率（the percentage of atrial pacing,AP%）、心室起搏比率（the percentage of ventrivular pacing,VP%）、心房高频事件（atrial high rate events,AHRE）发作日期和时长等参数。心房颤动定义为患者有〉5min的AHRE。根据首次检测到AHRE时之前的累积心房起搏比率将患者分为三组：低心房起搏比率组（AP%〈30%,n=75）、中心房起搏比率组（30%≤AP%〈60%,n=54）和高心房起搏比率组（AP%≥60%,n=42）组。比较三组间一般情况、并存疾病、左心房增大、心室起搏比率和心房颤动发生率。结果：三组间在性别、年龄、高血压、糖尿病、高脂血症、冠心病、脑梗死、左心房增大、心室起搏比率方面差异无统计学意义（P〉0.05）,但心房颤动的发生率差异具有统计学意义（P〈0.01）;事件曲线显示三组心房颤动发生率的不同,且差异具有统计学意义（P〈0.05）;多因素Logistic回归分析显示：心房起搏比率（AP%）≥60%（OR：4.62,95%CI：1.65~12.97,P=0.004）,高血压（OR：4.03,95%CI：1.32~12.34,P=0.015）、左心房增大（OR：5.79,95%CI：2.07~16.19,P=0.001）是SSS患者起搏器术后心房颤动发生的独立危险因素。结论：心房起搏比率与SSS患者起搏器术后心房颤动的发生率相关,AP%≥60%、高血压、左心房增大,是SSS患者起搏器术后心房颤动的独立危险因素。
Objective：To investigate the relationship of atrial pacing and atrial fibrillation in patients with sick sinus syndrome after implantation of dual-chamber pacemaker, and offer valuable reference for optimal programming of pacemakers. Method： From September 2012 to March 2014 in Beijing anzhen hospital, a total of 171 cases of sick sinus syndrome（ SSS）, without history of atrial fibrillation were enrolled in our study, with dual-chamber pacemaker implanted for the first time. Each patient was followed up at 1 month, 3 months, half a year and 1 year after the operation. The diagnostic data were retrieved from the implanted pacemaker, obtaining the percentage of atrial pacing （ AP% ） and ventricular pacing （ VP% ）, the initiation date and duration of AHRE. The data of AP% and VP% for analyzing was defined as the comulative value from the postoperative day to the onset date of AHRE. Patients were divided into three groups based on AP% ： low proportion group （ AP% 〈 30%, n = 75 ）, moderate proportion group （ 30% ≤ AP% 〈 60%, n = 54 ） and high proportion group （ AP% ≥60% ,n = 42）. Comparison of gender, age, hypertension, diabetes, hyperlipidemia, cerebral infare-tion, coronary heart disease, left atrial enlargement, VP%, incidence of AF in three groups. Time to initiation of AF was compared using the event curves. Logistic regression analysis was undertaken for several variables to examine for independent predictors of the initiation of AF. Result： A total of 22 cases （ 12. 9% ） were detected for more than 5min AHRE during the follow-up. Comparison of gender, age, hypertension, diabetes, hyperlipi- demia, cerebral infarction, coronary heart disease, left atrial enlargement and VP in three groups showed no significant difference（ P 〉 0. 05 ） , except for the incidence of AF（ P 〈 0. 01 ）. The event curve showed signifi- cant difference in the incidence of AF of the three groups （ P 〈 0.05 ）. Multivariate logistic regression analysis showed AP ≥60% （ OR：
出处
《心肺血管病杂志》
CAS
2015年第10期752-756,共5页
Journal of Cardiovascular and Pulmonary Diseases
基金
北京市教育委员会科学计划面上项目(KM201410025019)
