Objective To explore the features and significance of ambulatory electrocardiogram of patients with conduction block and sinus node dysfunction after implantation of dual chamber pacing (DDD) pacemaker.Methods One hundred and fifty patients after DDD pacemaker implantation undergoing 12-channel dynamic electrocardiogram were enrolled.The patients were divided into conduction block group (75 cases) and sinus node dysfunction group (75 cases) according to the indications of pacemaker therapy.The features of ambulatory electrocardiogram, perception and pacing functions of the pacemaker, work mode of the pacemaker, primary arrhythmia and pacemaker related arrhythmia were compared between groups.Results The detection rate of pacing percentage≥60％ was significantly higher than that of pacing percentage ＜60％ in both groups [88.0％ (66/75) vs 12.0％ (9/75), 85.3％ (64/75) vs 14.7％ (11/75)], while no significant difference was found between groups (P ＞ 0.05).Detection rate of AAI work mode in conduction block group was significantly lower than that in sinus node dysfunction group [0.0％ (0.0) vs 33.3％ (25/75)], detection rate of VDD/VAT work mode in conduction block group was significantly higher than that in sinus node dysfunction group [53.3％ (40 /75) vs 20.0％ (15/75)] (P ＜ 0.001);detection rate of DDI work mode was not significantly different between groups [46.7％ (35/75) vs 46.7％ (35/75)] (P ＞ 0.05).The detection rate of safe ventricular pacing in conduction block group was significantly lower than that in sinus node dysfunction group [10.7％ (8/75) vs 24.0％ (18/75)] (P ＜ 0.05).The detection rate of ventricular pacing fusion wave in conduction block group was significantly higher than that in sinus node dysfunction group [52.0％ (39/75) vs 34.7％ (26/75)] (P ＜ 0.05).The detection rates of rapid ventricular pacemaking triggered by atrial tachycardia and pacemaker mediated tachycardia in conduction block group were significantly lower than those in sinus node dysfunction group [13.3％ (10/75) vs 26.7％ (20/75) , 2.7％ (2/75) vs 12.0％ (9/75)] (P ＜ 0.05).The detection rates of atrial tachycardia and frequent atrial premature beat in conduction block group were significantly lower than those in sinus node dysfunction group [17.3％ (13/75) vs 38.7％ (29/75), 2.7％ (2/75) vs 22.7％ (17/75)] (P ＜ 0.01).Conclusions After pacemaker implantation, ambulatory electrocardiogram monitoring can be used to distinguish the major work mode in different DDD indications and comprehensively learn the pacemaker working status, which would provide important and accurate references for treatment of arrhythmia and contol of pacemaker programming process.%目的 探讨传导阻滞与窦房结功能不良患者双腔起搏器(DDD)置入后动态心电图的表现及其意义.方法 对2009年3月至2014年3月于陕西省延安市人民医院安装DDD型人工心脏起搏器的150例患者进行动态心电图分析,根据起搏器治疗适应证将其分为传导阻滞组(75例)和窦房结功能不良组(75例),对2组患者DDD起搏器的动态心电图表现、主要工作模式、心室起搏情况、自身心律失常及与起搏器相关的心律失常进行分析、判断和比较.结果 传导阻滞组和窦房结功能不良组起搏比例≥60％者均多于起搏比例＜60％者[88.0％ (66/75)比12.0％ (9/75)、85.3％(64/75)比14.7％ (11/75)],2组差异无统计学意义(P＞0.05).传导阻滞组患者起搏器心房按需起搏工作模式的检出率明显低于窦房结功能不良组[0.0％(0.0)比33.3％ (25/75)],心室按需起搏/心房同步心室起搏工作模式检出率明显高于窦房结功能不良组[53.3％ (40/75)比20.0％(15/75)](均P＜0.001);双腔按需起搏工作模式检出率2组比较差异无统计学意义[46.7％ (35/75)比46.7％(35/75)](P＞0.05).传导阻滞组患者心室安全起搏的检出率明显低于窦房结功能不良组[10.7％ (8/75)比24.0％ (18/75)],心室起搏融合波的检出率明显高于窦房结功能不良组[52.0％(39/75)比34.7％ (26/75)](均P＜0.05).传导阻滞组患者起搏介导性心动过速和感知房性心动过速触发快速心室起搏的检出率明显低于窦房结功能不良组[2.7％ (2/75)比12.0％(9/75),13.3％ (10/75)比26.7％(20/75)],房性心动过速和频发房性期前收缩的检出率明显低于窦房结功能不良组[17.3％ (13/75)比38.7％(29/75),2.7％(2/75)比22.7％(17/75)],差异均有统计学意义(均P＜0.01).结论 不同患者DDD起搏器置入后相应的主要工作模式可以通过动态心电图的各种表现进行识别,对起搏器的工作状态进行全面的了解,可以为自身心律失常的治疗和起搏器的合理程控等提供准确的依据.
展开▼
