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目的通过对起搏器参数的优化,尽可能减少心室起搏,提高患者生活质量。方法 2005年1月~2013年10月在我院病态窦房结综合征(SSS)患者植入双腔起搏器后心室起搏时诉胸闷、心悸不适,82例患者,设置最长的房室间期(AVD),延长心室后心房不应期(PVARP)至450ms,关闭心室自动阈值夺获功能,如仍有不适症状,通过起搏器程控仪较长时间监测或Holter等检查方法查找发生心室起搏的原因,并进行相应的处理。结果 62例病人症状消失,仍有20例有不适症状。导致心室起搏的原因及处理方法如下:(1)2例活动后因起搏器频率适应性功能致心房起搏频率增加后,出现二度I型房室阻滞,关闭频率适应性起搏功能后症状缓解;(2)2例因心房误感知设置较高的感知灵敏度后心室起搏消失;(3)2例提高心房起搏电压,1例重新植入心房电极,解决了心房失夺获从而避免了心室起搏;(4)5例阵发性房速/房扑患者缩短心室后心房空白期,使模式转换能发生,3例心房率较慢的房速患者设置为DDI模式,5例房颤患者降低下限频率,减少了心室起搏。结论心室起搏心律不适患者设置较长的AV间期,设置PVARP 450ms,关闭心室自动阈值夺获功能,如仍有不适症状,通过起搏器程控仪进行较长时间的心电监护或动态心电图检查找出导致心室起搏的原因,并对起搏器相关参数进行设置,能有效减少或消除心室起搏。
Objective To optimize pacemaker parameters to minimize ventricular pacing and improve patient quality of life. Methods From January 2005 to October 2013, we complained of chest tightness and palpitations discomfort in patients with sick sinus syndrome (SSS) after implantation of double chamber pacemaker. In 82 patients, the longest room (AVD), extend the atrial patency (PVARP) to 450ms, turn off the automatic threshold capture of ventricular function, such as still have symptoms, through the pacemaker programmer for a long time monitoring or Holter and other inspection methods to find Ventricular pacing occurred and the corresponding treatment. Results 62 patients disappeared symptoms, there are still 20 cases of discomfort. Ventricular pacing caused by the causes and treatment are as follows: (1) 2 cases of activity due to adaptive pacemaker frequency of atrial pacing caused by increased frequency of second-degree I-type atrioventricular block, the closure of frequency-adaptive pacing (2) two cases of ventricular pacing disappeared after setting a higher sensitivity sensitivity due to atrial misoperation; (3) two cases improved atrial pacing voltage and one case re-implanted atrial electrode to solve the problem of atrial deprivation (4) 5 patients with paroxysmal atrial tachycardia / atrial flutter shorten the atrial ventricular white space after ventricular, mode switching can occur, 3 cases of atrial tachycardia patients with atrial tachycardia set to DDI mode, Five patients with atrial fibrillation lower limit frequency, reducing ventricular pacing. Conclusion Patients with ventricular pacing arrhythmia set a longer AV interval, set PVARP 450ms, turn off the automatic threshold capture of ventricular function, such as still have symptoms, through the pacemaker programmer longer ECG or Holter monitoring Check to find out the cause of ventricular pacing and pacemaker-related parameters set can effectively reduce or eliminate ventricular pacing.