生理性起搏的新进展.ppt

* By definition, single chamber AAIR pacing will eliminate the possibility of RV pacing and may provide effective therapy for SND patients with intact AV conduction. However, this option carries with it too much risk, due to the unpredictable possibility of patients developing AV block and/or AF with ventricular bradycardia over the life of their devices. In these cases, AAIR pacing is both inappropriate and ineffective for preventing symptomatic bradycardia, which is the fundamental purpose of cardiac pacing. * AV block is uncommon during long-term follow-up in the majority of patients with SND, but total prevalence risks of up to 11.9% have been reported2. In aggregate, data from 28 different studies on atrial pacing for SND showed a median annual incidence of third degree AV block of 0.6% (0%-4.5%) with a total prevalence 2.1% (0-11.9%). There was no significant difference in follow-up time between studies that showed a low, compared to a high incidence of AV block. Variability in the reported incidence of persistent heart block likely relates to the exclusion of patients with bifascicular block or left bundle branch block in some studies, with lower incidences and inclusion in others with higher incidences. Though these studies confirm the infrequent development of second and third degree AVB during AAIR pacing, they failed to emphasize that AVB is a potentially life-threatening complication. * Long AV delays among patients with intact AV conduction may reduce unnecessary ventricular pacing in the DDDR mode. By operating in the functionally AAIR mode this may optimize hemodynamics by maintaining the normal ventricular activation sequence (in the absence of underlying bundle branch block). Optimal DDDR pacemaker programming among patients with intact but delayed AV conduction is problematic. Programming long pacemaker AV delay compromises upper rate behavior and atrial tachyarrhythmia detection in devices that ignore atrial events that fall in the AV int