作者：魏冰倩1 ，蓝荣芳1，2 ，徐伟1，2 ，吴翔2 ，王天琦2 ，王宇2 ，王吉芳2

单位：

1.210008江苏省南京市，南京医科大学鼓楼临床医学院　2.210008江苏省南京市，南京大学医学院附属鼓 楼医院心血管内科

Units：

1.Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China 2.Department of Cardiovascular, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China

关键词：

心动过缓；心律失常，心性；快速型房性心律失常；心房抗心动过速起搏

Keywords：

Bradycardia; Arrhythmias, cardiac; Atrial tachyarrhythmia; Atiral antitachycardia pacing

CLC：

R 541.72 R 541.7

DOI：

10.12114/j.issn.1008-5971.2024.00.106

Funds：

摘要：

目的　分析心房抗心动过速起搏（aATP）在心动过缓合并快速型房性心律失常（ATA）患者中 的应用效果。方法　回顾性选取2019年12月—2022年12月在南京大学医学院附属鼓楼医院心血管内科植入具有 aATP功能的双腔永久起搏器的心动过缓合并ATA患者8例为研究对象，其均于术中或随访期间开启aATP功能， 起搏器识别到ATA发作时会自动开启aATP干预〔如为心房颤动（AF）发作，则不进行干预〕，所有患者首先采 用周长递减起搏（Ramp）方案进行起搏，若ATA终止失败，则继续尝试以Ramp或短阵快速起搏（Burst＋）方 案进行起搏。收集并分析患者腔内心电图检查结果，记录患者首次aATP干预前ATA负荷、每日ATA持续时间， 首次aATP干预后3个月ATA负荷、每日ATA持续时间、ATA周长、ATA终止成功率。结果　1例患者开启aATP功 能后发生了ATA，但其自行终止，因而未接受aATP干预，之后未再复发；1例患者开启aATP功能后发生了心房 扑动（AFL），但其转为了AF，因而未接受aATP干预；其余6例患者开启aATP功能后发生了AFL或房性心动过 速（AT），随后接受了aATP干预。腔内心电图检查结果显示，6例接受aATP干预患者的ATA均为来源于右心房 的典型AFL，且aATP干预可终止的AFL节律均相对规则且缓慢。6例接受aATP干预患者首次aATP干预前ATA负荷 为＜0.1%～93.3%，每日ATA持续时间为＜0.1～22.4 h；首次aATP干预后3个月ATA负荷为0～40.2%，每日ATA持续 时间为0～9.6 h，ATA周长为249～395 ms，ATA终止成功率为17.2%～100.0%，总ATA终止成功率为32.1%（1 222/ 3 806）。结论　aATP干预可终止的AFL节律均相对规则且缓慢；aATP可降低心动过缓合并ATA患者ATA负荷，缩短 ATA持续时间，但其ATA终止成功率不高，为32.1%。

Abstract：

Objective To analyze the application effect of atrial antitachycardia pacing (aATP) in bradycardia patients combined with atrial tachyarrhythmia (ATA) . Methods A total of 8 bradycardia patients combined with ATA who were implanted with double-chamber permanent pacemaker with aATP function in the Department of Cardiovascular, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from December 2019 to December 2022 were selected as the study objects. All of them had aATP function turned on during the operation or during follow-up. When the pacemaker recognized an ATA attack, it would automatically activate aATP intervention (if it was an atrial fibrillation (AF) attack, no intervention would be performed) . All patients were first paced with the decreasing perimeter pacing (Ramp) program, and if ATA failed to terminate, they continued to try the Ramp or short array rapid pacing (Burst＋) program. The results of intracavitary electrocardiogram were collected and analyzed, and ATA load, and daily ATA duration before the first aATP intervention, ATA load, daily ATA duration, ATA circumference, and ATA termination success rate at 3 months after the first aATP intervention were recorded. Results ATA occurred in 1 patient after aATP function was turned on, but it terminated spontaneously, so the patient did not receive aATP intervention and did not recur later. One patient experienced atrial flutter (AFL) after activating aATP function, but it turned into AF, so the patient did not receive aATP intervention. The remaining 6 patients developed AFL or atrial tachycardia (AT) after activating aATP function, and subsequently received aATP intervention. The results of intracavitary electrocardiogram showed that the ATA of the 6 patients who received aATP intervention were typical AFL originating from the right atrium, and the AFL rhythm that could be terminated by aATP intervention was relatively regular and slow. In the 6 patients who received aATP intervention, before the first aATP intervention, the ATA load was < 0.1%-93.3%, and the daily ATA duration was < 0.1-22.4 h; at 3 months after the first aATP intervention, the ATA load was 0-40.2%, the daily ATA duration was 0-9.6 h, the ATA circumference was 249-395 ms, the ATA termination success rate was 17.2 %-100.0%, and the total ATA termination success rate was 32.1% (1 222/3 806) . Conclusion The AFL rhythm that can be terminated by aATP intervention is relatively regular and slow. aATP can reduce ATA load and shorten ATA duration in bradycardia patients combined with ATA, but the success rate of ATA termination is not high (32.1 %) .

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