摘要
目的观察永久性心房颤动（房颤）伴缓慢心室率患者希氏束起搏的R在T上（ROYIT）起搏现象发生情况，探讨解决方法。方法2015年7月至2016年7月在南京医科大学第一附属医院因永久性房颤伴缓慢心室率或长RR间期行希氏束起搏的患者18例，希氏束起搏导线插入脉冲发生器心房接口，所有患者均同时植入心室备用导线并连接心室接口，程控脉冲发生器为DDD模式，低限频率60次／min，PAV、SAV间期均为250ms，关闭心室安全起搏功能。出院后首次随访程控测试并记录AP-VP的比例，程控调整AV问期观察心电图变化情况。结果18例患者中男12例（66．7％），术前动态心电图平均心室率（48．28±11．0）次／min，最长RR间期平均值（2．96±0．87）s。植入参数：希氏束导线R波感知（3．97±1．60）mV，术中阈值（1．24±0．85）V／0．5ms，出院后随访测试起搏阈值（1．18±0．72）V／0．4ms，程控时观察到PAV间期为250ms时，AP-VP表现为RonT起搏现象，18例患者中有17例（94．4％）测试AP-VP比例〉0；平均AP-VP百分比为3．02％±466％。缩短PAV间期为100～150ms后心室脉冲发放均落在QRS终末部分心室绝对不应期从而避免RonT起搏。结论慢心室率房颤患者希氏束起搏后默认设置的长AV间期导致的ROilT起搏现象非常常见；缩短AV间期可有效预防RonT起搏现象。
Objective It was to illuminate the R on T pacing phenomenon after HIS bundle pacing （HBP）in patients with chronic atrial fibrillation and slow ventricular response, and to find an appropriate ap- proach to solve it. Methods Eighteen patients who had a history of chronic atrial fibrillation with a slow ven- tricular response, normal activation interval（ QRSd〈 120 ms ）were screened for permanent HBP. After successful HBP, a right ventricular lead was implanted into ventricular septum. The HBP lead and ventrieular lead were plugged into the atrial and ventricular ports of the pacemaker respectively. The pacemaker was programmed as DDD mode, PAV/SAV interval = 250 ms, and 60 beats per minute for low rate limit. The percentage of AP-VP at the first follow up and also the ECG during AP-VP mode at different AV interval was recorded. Results Aver- age heart rate of 18 patients was （48.28±11.0 ）beats per minute before the procedure. Permanent HBP was suc- cessful in all patients who received dual-chamber pacemakers. Acute pacing HBP threshold was （ 1.24±0. 85 ） V/O. 5 ms;sensed R wave potential was （3.97±1.60）mV. The HBP threshold was comparable （1.18±0. 72 ）V/ 0.4 ms at one month follow up. R on T pacing phenomenon could be recorded while the AV interval was set at 250 ms. 17 patients（94. 4% ）had a history of AP-VP,the average percentage of AP-VP was 3.02% ±4. 66%. Ventricular stimulation delivered at the absolute refractory period and diminished the R on T phenomenon while the AV interval was programmed at 100 - 150 ms. Conclusion R on T pacing phenomenon after HIS bundle pacing in patients with chronic atrial fibrillation is very common; a short AV interval of 100 - 150 ms is an appropriate choice to avoid R on T pacing.
出处
《中华心律失常学杂志》
2017年第3期234-237,共4页
Chinese Journal of Cardiac Arrhythmias
