起搏器植入的老年患者不同起搏模式微伏级T波电交替研究

摘要

目的 通过动态心电图分析植入起搏器的老年患者微伏级T波电交替的情况,研究不同起搏模式对T波电交替的影响. 方法 入选33例植入起搏器的老年患者,通过12导长程心电监测记录24 h心电图,通过时域分析法分析微伏级T波电交替的情况. 结果 33例患者中16例记录到微伏级T波电交替,其中心室起搏8例,心房起搏3例,心房心室同时起搏2例,未起搏3例.在心室起搏模式下T波电交替的阳性率为44.4％,心房起搏模式下T波电交替的阳性率为30.0％(P=0.033).心室起搏模式和心房起搏模式下T波电交替的交替值分别为(132±85)μV和(25±8)μV (P=0.002),心室起搏模式和心房起搏模式下出现T波电交替的平均导联数为(5.5±2.9)个和(1.0±0.0)个(P=0.020). 结论 植入起搏器的老年患者心室起搏模式下T波电交替发生率和交替值高于心房起搏模式,心室起搏可能增加老年人心肌细胞电不稳定性.%Objective To study the microvolt T-wave alternans (MTWA) in elderly patients with pacemaker implantation by holter analysis,and to investigate the effect of different pacing modes on T-wave alternant.Methods 33 patients with pacemaker implantation were enrolled.Electrocardiograph (ECG) was recorded by 12-lead Holter for 24 hours and microvolt T-wave alternans (MTWA) were analyzed by time domain analysis.MTWA were recorded recalling the ECG to observe the pacemaker modes.Results MTWA was found in 16 patients,in which ventricular pacing was found in 8 cases,atrial pacing in 3 cases,double chamber pacing in 2 cases,and no pacing in 3 cases.The positive rate of MTWA was 44.4％ and 30.0％ in the ventricular pacing and atrial pacing modes respectively (P =0.033).There were significant differences in alternant value and average leads of MTWA between ventricular pacing mode and atrial pacing mode [(132± 85) μV vs.(25±8) μV,(5.5±2.9) vs.(1.0±0.0),P=0.002 and0.020].Conclusions The incidence of MTWA and alternant value are higher in ventricular pacing mode than in atrial pacing mode in elderly pacemaker patients,which indicates that ventricular pacing may increase myocardial electrical instability.