瓣膜置换术后窦性心动过缓VVI与DDD起搏的随访观察

摘要

Objective To compare the clinical effects of VVI and DDD pacing in sinus bradycardia in patients after valve replacement. Methods All 29 patients with sinus bradycardia after valve replacement were divided into 2 groups by different pacing-mode:DDD group(n = 17) ,VVI group(n = 12). The changes of left ventricular ejection fraction, fractional shortening and the size of atrial ventricular, the occurrence of permanence atrial fibrillation(AF) , the hospitalization for heart failure, the stroke and the death were followed up. Results Mean follow-up was 28 months; All patients had no complications in pacemaker implantation. There was none of stroke and death during the follow-up period. The incidence rate of permanence AF in DDD group was significantly lower than that in VVI group; The hospitalization rate for heart failure in DDD group was significantly lower than that in VVI group . The left atrial volume and diameter in VVI group was significantly increased compared with baseline,but which were not significantly increased in DDD group; The ejection fraction in VVI group was lower than that in DDD group( 0.57 ± 0.08 vs 0.63 ± 0.10, P < 0.05 ). Conclusion Compare to VVI pacing,DDD pacing gets the lower ratio of permanent AF, the lower ratio of the hospitalization for heart failures and improves the cardiac remodelling and function in patients who have sinus bradycardia after valve replacement. [ Chinese Journal of Cardiac Pacing and Electrophyswlogy,2011,25(4) :313 -315]%目的 探讨VVI与DDD起搏对瓣膜置换术后窦性心动过缓患者疗效的差异.方法 瓣膜置换术后窦性心动过缓患者29例,按不同起搏方式分为:DDD组（n=17例）,VVI组（n=12例）,观察左室射血分数,短轴缩短率,心房心室变化,永久性心房颤动（简称房颤）,卒中,心力衰竭（简称心衰）住院,死亡的发生.结果 两组患者均未发生起搏器安置术并发症,在平均随访28个月,未发生卒中、死亡.与VVI组比较,DDD组心衰住院率(10.5％ vs 16.6％,P＜0.05),永久性房颤发生率降低(11.7％vs 16.6％,P＜0.05),左室射血分数增加(0.63±0.10 vs 0.57±0.08,P＜0.05).VVI组起搏后左房内径,左房容积增大,而DDD组不变.两组心功能均提高且无差异.结论 对于瓣膜置换术后窦性心动过缓患者,DDD起搏较WI起搏降低永久性房颤发生率,心衰住院率,改善心脏结构和心功能.