Features and significance of ambulatory electrocardiogram of patients with conduction block and sinus node dysfunction after implantation of dual chamber pacing pacemaker

Zhang Xuemei; Feng Jing; Tang Xihong

doi:10.3760/cma.j.issn.1673-4777.2016.01.005

Abstract：Objective To explore the features and significance of ambulatory electrocardiogram of patients with conduction block and sinus node dysfunction after implantation of dual chamber pacing (DDD) pacemaker.Methods One hundred and fifty patients after DDD pacemaker implantation undergoing 12-channel dynamic electrocardiogram were enrolled.The patients were divided into conduction block group (75 cases) and sinus node dysfunction group (75 cases) according to the indications of pacemaker therapy.The features of ambulatory electrocardiogram, perception and pacing functions of the pacemaker, work mode of the pacemaker, primary arrhythmia and pacemaker related arrhythmia were compared between groups.Results The detection rate of pacing percentage≥60％ was significantly higher than that of pacing percentage ＜60％ in both groups [88.0％ (66/75) vs 12.0％ (9/75), 85.3％ (64/75) vs 14.7％ (11/75)], while no significant difference was found between groups (P ＞ 0.05).Detection rate of AAI work mode in conduction block group was significantly lower than that in sinus node dysfunction group [0.0％ (0.0) vs 33.3％ (25/75)], detection rate of VDD/VAT work mode in conduction block group was significantly higher than that in sinus node dysfunction group [53.3％ (40 /75) vs 20.0％ (15/75)] (P ＜ 0.001);detection rate of DDI work mode was not significantly different between groups [46.7％ (35/75) vs 46.7％ (35/75)] (P ＞ 0.05).The detection rate of safe ventricular pacing in conduction block group was significantly lower than that in sinus node dysfunction group [10.7％ (8/75) vs 24.0％ (18/75)] (P ＜ 0.05).The detection rate of ventricular pacing fusion wave in conduction block group was significantly higher than that in sinus node dysfunction group [52.0％ (39/75) vs 34.7％ (26/75)] (P ＜ 0.05).The detection rates of rapid ventricular pacemaking triggered by atrial tachycardia and pacemaker mediated tachycardia in conduction block group were significantly lower than those in sinus node dysfunction group [13.3％ (10/75) vs 26.7％ (20/75) , 2.7％ (2/75) vs 12.0％ (9/75)] (P ＜ 0.05).The detection rates of atrial tachycardia and frequent atrial premature beat in conduction block group were significantly lower than those in sinus node dysfunction group [17.3％ (13/75) vs 38.7％ (29/75), 2.7％ (2/75) vs 22.7％ (17/75)] (P ＜ 0.01).Conclusions After pacemaker implantation, ambulatory electrocardiogram monitoring can be used to distinguish the major work mode in different DDD indications and comprehensively learn the pacemaker working status, which would provide important and accurate references for treatment of arrhythmia and contol of pacemaker programming process.