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目的分析起搏器植入患者中,出现晚期可逆性阈值升高的原因,探求解决方法。方法回顾性分析在2003~2012年本院植入起搏器的1 143例患者,对出现晚期可逆性阈值升高的7例患者的疾病特点进行总结。结果7例患者中,4例出现黑矇或短暂意识丧失,心电图存在失夺获表现;1例心房起搏失夺获,但心室起搏功能良好,无临床症状;2例因安装有具有阈值自动管理功能起搏器,无临床症状。7例的心房基线阈值为0.5~0.75 V,心室基线阈值为0.5~0.75 V,并发急性病情时,6例心室阈值均超过2.5 V,1例心房阈值超过2.5 V。7例患者都有不同的急症,包括大面积烧伤、慢性肾功能不全急性加重、心功能衰竭并呼吸衰竭,导致了酸中毒、高钾血症、心肌缺血缺氧。在急症缓解后,7例心房、心室阈值出现下降,心房阈值降为0.5~1.0 V,心室阈值降为0.5~1.5 V,起搏器在原有参数设置下工作恢复了正常。结论心功能不全、呼吸衰竭、肾功能不全等疾病可引起心肌外环境异常,导致晚期起搏阈值突然升高,具有阈值自动管理功能的起搏器可适时调节起搏阈值。
Objective To analyze the causes of the late reversible threshold increase in patients undergoing pacemaker implantation and to find solutions. Methods A total of 1 143 patients with pacemakers implanted in our hospital from 2003 to 2012 were retrospectively analyzed. The disease characteristics of 7 patients with elevated late reversibility threshold were summarized. Results Among the 7 patients, 4 cases had amaurosis or short-term loss of consciousness, and the electrocardiogram was lost. One patient lost the atrial pacing and had good ventricular pacing function without any clinical symptoms. Automatic management of pacemakers, no clinical symptoms. In seven cases, the baseline atrial threshold was 0.5-0.75 V, and the baseline of the ventricles was 0.5-0.75 V. In acute cases, the ventricular thresholds in 6 cases exceeded 2.5 V and in 1 case the atrial threshold exceeded 2.5 V. All 7 patients had different emergency conditions, including extensive burns, acute exacerbation of chronic renal insufficiency, heart failure and respiratory failure, resulting in acidosis, hyperkalemia and myocardial ischemia and hypoxia. After acute relief, 7 cases of atrial, ventricular threshold decreased, atrial threshold decreased to 0.5 ~ 1.0 V, ventricular threshold decreased to 0.5 ~ 1.5 V, the pacemaker in the original parameters set to work back to normal. Conclusions Cardiac insufficiency, respiratory failure, renal insufficiency and other diseases can lead to abnormal myocardial extracellular environment, resulting in a sudden increase of late pacing threshold. Pacemakers with automatic threshold management can adjust pacing threshold timely.