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病例介绍患者男性,71岁,因冠心病,慢-快综合征,窦性静止4.4s于1987年11月安置国产AXB-3型VVI起搏器,术前用Medtron ic 5309起搏器分析仪测试其不应期292ms。术后半年动态心电图随访发现起搏周期的后期,起搏器感知功能不良(见图1)。图1中可见起搏脉冲72ppm,间期832ms,第1个脉冲起搏心室;第3、5、7个脉冲前QRS波为室上性的,但不被起搏器感知。第2、4、6个QRS波为融合波。根据动态心电图记录,于脉冲前280ms之内的心脏自身激动R波一律不被感知,但在280ms之前的自身R波则可被感知。再向前,即在前一脉冲后的300ms左右,又不能感知(起搏工程设计的不应期,见图2)。因此,在起搏周期中,832-280-300=252ms范围内的自身R波,才可被感知。当心脏自搏频率(房颤律)增快至90
Case description Male, 71 years old, with coronary heart disease, slow-fast syndrome, sinus rest 4.4s In November 1987, a home-made AXB-3 VVI pacemaker was placed. Preoperative Medtron ic 5309 pacemaker analyzer Test its refractory period 292ms. Six months after the follow-up of the Holter found that the pacemaker period, the pacemaker perception of dysfunction (see Figure 1). Figure 1 shows the pacing pulse of 72ppm, the interval of 832ms, the first pulse pacing ventricular; the first 3,5,7 pulse QRS wave of supraventricular, but not perceived by the pacemaker. The 2nd, 4th and 6th QRS waves are fusion waves. According to the Holter recording, the heart’s own excited R wave within 280 ms before the pulse was not sensed at all, but the self-R wave before 280 ms was perceivable. Then forward, that is, about 300ms after the previous pulse, and can not be perceived (pacing engineering design refractory period, see Figure 2). Therefore, during the pacing cycle, the self-R wave in the range of 832-280-300 = 252 ms can be perceived. When the heart rate of spontaneous (atrial fibrillation) increased to 90