三腔起搏器的临床应用

李海宴　张英川　陈慧敏　方冬平 心肺血管病杂志 1999年第3期第18卷 临床论著

　　摘要　应用三腔起搏器治疗病窦以及同时有房室传导异常合并快速房性心律失常患者6例，其中5例为阵发房颤，1例为阵发房扑，心电图示房间阻滞。植入冠状窦电极及普通右房和右室电极，用Y型转换器以右房耳电极为负极，冠状窦电极为正极构成新的双极电极。将4例患者DDD起搏器调至AAT模式，2例患者为DDD模式，房性快速心律失常消失。随访2～6个月，疗效满意。三腔心脏起搏器适用于治疗病窦并有房室传导异常 合并房内阻滞的阵发房扑和房颤的患者。

Clinical Application of Trichamber Cardiac Pacemaker

Li Haiyan,Zhang Yingchuan,Chen Huimin,et al.

Beijing Anzhen Hospital(100029)

　　Abstract　Six patients of sick sinus syndrome (SSS) with abnormal atrioventricular conduction were implanted with biatrial trichamber pacemaker.Five of them were accompanied with paroxysmal atrial fibrillation and the other one with paroxysmal atrial flutter.All of them showed intraatrial conduct ion block on ECG.Three leads were implaced into coronary sinus(CS),right auricle( RA) and right ventricle(RV).RA lead and CS lead were connected with Y shape adap ter to reform a new biatrial bipolar lead.DDD Pacemaker were implanted.Four of them were configured to AAT Mode and the two others still DDD mode.No atrial fib rillation and flutter was found when being followed up 2～6 months.It s concluded that biatrial trichamber pacemaker can successfully prevent atrial fibrillation and flutter in SSS and abnormal atrioventricular conduction patients with intraat rial conduction block.

　　Key words: Coronary sinus lead; B iatrial trichamber pacemaker; Paroxysmal atrial fibrillation; Paroxysmal atrial flutter; Intraatrial conduction block

　　部分病窦和房室传 导阻滞患者合并阵发性房性快速心律失常，其表现为阵发房速、阵发房颤和房扑，可以交替、反复发作。这些患者伴有不同程度的房间阻滞，难以应用抗心律失常药物，且疗效差。近年应用人工心脏起搏器治疗快速心律失常取得了一定的疗效［1］，特别是三腔起搏器治疗合并快速房性心律失常的病窦和房室传导异常效果满意，我院自1998年7月～1999年1月完成6例，现总结如下。

　　资料和方法

　　1.病例选择与临床资料　本组6例患者，男性4例，女性2例，年龄64～80(平均71)岁。6例均患病窦，其中5例合并阵发房颤，1例为阵发房扑。发作时有胸憋，心悸症状，近2个月发作次数3～17次，平均5±3.2次。术前ECG或HOLTER证实。有2例患者在院外诊断房颤，给予口服心律平150mg Tid治疗疗效差。体表心电图示房间阻滞，P波时限≥120ms,P波切迹形成双峰间距＞40ms。术前行电生理检查，6例患者窦房结恢复时间≥1800ms，均有房间阻滞，房间传导时间≥100ms,4例文氏点≤110次/min，2例为≤90次/min，提示房室传导异常。

　　2.电极和起搏器的植入　同时植入三根电极，冠状窦

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