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目的:研究置入起搏器5年以上患者新出现起搏器依赖及右室起搏相关心室不同步的情况。方法:选取置入时为非起搏器依赖且置入起搏器已超过5年患者272例进行随访,测量自身心率,记录心室起搏比例;将起搏器心室频率逐渐降至30次/min,观察30s,无患者自身心律出现,判定为起搏器依赖;将自身心率<50次/min且心室起搏比例>90%者判定为右室起搏相关心室不同步患者,对起搏器依赖及右室起搏相关心室不同步患者提出个别随访方案和更换建议。结果:136例病窦综合征患者中有4例(2.9%)进展为起搏器依赖;116例房室传导阻滞患者中有10例(8.6%)进展为起搏器依赖;全部病例有15例(5.5%)进展为起搏器依赖;有43例自身心率<50次/min且心室起搏比例>90%,占全部病例的15.8%。结论:房室传导阻滞患者较之病窦综合征患者,更容易进展为起搏器依赖患者;置入起搏器5年以上患者中约有5.5%进展为起搏器依赖;置入起搏器5年以上患者中右室起搏相关心室不同步人群比例约15.8%。
PURPOSE: To study the new pacemaker-dependent and right ventricular-pacing-related ventricular dyssynchrony in patients who have been implanted in a pacemaker for more than 5 years. Methods: A total of 272 patients with non-pacemaker dependence and pacemaker implantation for more than 5 years were selected for follow-up. The heart rate was measured and the ventricular pacing rate was recorded. The pacemaker ventricular rate was gradually reduced to 30 times / min, observed for 30s, no patient’s own heart rhythm, was judged as dependent on pacemaker; their heart rate <50 beats / min and ventricular pacing rate> 90% were judged as right ventricular pacing-related ventricular dyssynchrony patients on pacing Dependent and right ventricular pacing related ventricular dyssynchrony patients proposed individual follow-up program and replacement recommendations. RESULTS: Four of the 136 patients with sick sinus syndrome (2.9%) progressed to pacemaker dependence; 10 of 116 (8.7%) patients with atrioventricular block progressed to pacemaker dependence; and all had Fifteen patients (5.5%) were pacemaker dependent; 43 had their own heart rate <50 beats / min and the ventricular pacing rate was> 90%, accounting for 15.8% of all cases. CONCLUSIONS: Patients with atrioventricular block are more likely to develop Pacemaker-dependent patients than patients with STI, and approximately 5.5% of pacemakers who have been implanted with a pacemaker for more than 5 years are pacemaker-dependent The rate of right ventricular pacing-related ventricular dyssynchrony in patients with more than 5 years of pacemaker was about 15.8%.