Prospective randomized study of ablation and pacing versus medical therapy for paroxysmal atrial fibrillation: effects of pacing mode and mode-switch algorithm.
Prospective randomized study of ablation and pacing versus medical therapy for paroxysmal atrial fibrillation: effects of pacing mode and mode-switch algorithm.
复制标题
消融和起搏与阵发性心房颤动药物治疗的前瞻性随机研究：起搏模式和模式切换算法的影响。
DOI：
10.1161/01.cir.99.12.1587
复制
发表时间：
1999
期刊：
影响因子：
37.8
通讯作者：
M. Gammage
中科院分区：
文献类型：
--
作者：
H. Marshall;Z. Harris;M. Griffith;R. Holder;M. Gammage
背景
房室结消融和起搏已成为药物难治性阵发性房颤(PAF)的公认治疗方法。然而，很少有数据表明它比持续的药物治疗更优越。起搏模式和模式切换算法的影响尚未得到研究。
方法和结果
有症状的PAF患者随机分为内科治疗组(19例)或房室结消融加双腔模式转换起搏器(DDDR/MS)起搏器植入组(慢算法19例，快速算法18例)。每隔6周进行一次18周以上的随访，并使用生活质量问卷(心理总体幸福感[PGWB]、麦克马斯特健康指数[MHI]、心脏症状评分)、运动试验、超声心动图和动态心电图监测。起搏患者被随机分成DDDR/MS或VVIR，然后交换。消融和DDDR/MS起搏在总体症状(-41%，P<；0.01)、心悸(-58%，P=0)方面优于药物治疗。0001)和呼吸困难(-37%，P<；0.05)。与基线相比，消融和DDDR/MS起搏的总症状(-48%比-4%，P<；0.005)、心悸(-62%比-5%，P<；0.001)、呼吸困难(-44%比-3%，P<；0.005)和PGWB(+12%比+0.5%，P<；0)的积分变化更好。05)。在总体症状(-21%)、呼吸困难(-30%)和MHI(+5%)方面，DDDR/MS起搏优于VVIR起搏(P&0.005)。不同的算法没有区别。在6周时，消融和起搏的患者发生持续性房颤的人数多于药物治疗的患者(37例中12例，19例中0例，P<；0.01)。
结论
消融和DDDR/MS起搏比药物治疗或消融和VVIR起搏有更多的症状改善，但可能导致持续性房颤的早期发展。
BACKGROUND
Atrioventricular (AV) node ablation and pacing has become accepted therapy for drug-refractory paroxysmal atrial fibrillation (PAF). However, few data demonstrate its superiority over continued medical therapy. The influence of pacing mode and mode-switch algorithm has not been investigated.
METHODS AND RESULTS
Symptomatic patients who had tried >/=2 drugs for PAF were randomized to continue medical therapy (n=19) or AV junction ablation and implantation of dual-chamber mode-switching (DDDR/MS) pacemakers (slow algorithm [n=19] or fast algorithm [n=18]). Follow-up over 18 weeks was at 6-week intervals and used quality-of-life questionnaires (Psychological General Well Being [PGWB], McMaster Health Index [MHI], cardiac symptom score), exercise testing, echocardiography, and Holter monitoring. Paced patients were randomized to DDDR/MS or VVIR and subsequently crossed over. Ablation and DDDR/MS pacing produced better scores than drug therapy for overall symptoms (-41%, P<0.01), palpitations (-58%, P=0. 0001), and dyspnea (-37%, P<0.05). Changes in score from baseline were better with ablation and DDDR/MS pacing for overall symptoms (-48% versus -4%, P<0.005), palpitation (-62% versus -5%, P<0.001), dyspnea (-44% versus -3%, P<0.005), and PGWB (+12% versus +0.5%, P<0. 05). DDDR/MS was better than VVIR pacing for overall symptoms (-21%, P<0.05), dyspnea (-30%, P<0.005), and MHI (+5%, P<0.03). There were no differences between algorithms. More patients developed persistent AF with ablation and pacing than with drugs at 6 weeks (12 of 37 versus 0 of 19, P<0.01).
CONCLUSIONS
Ablation and DDDR/MS pacing produces more symptomatic benefit than medical therapy or ablation and VVIR pacing but may result in early development of persistent AF.