The Effects Of Physiologic And Nonphysiologic Pacing On Atrial Fibrillation, Cardiac Function And Cardiac Remodeling In Patients

Objective: To analysis the effects of physiologic and nonphysiologic pacing on atrial fibrillation, cardiac function and cardiac remodeling in patients and provide evidence for clinical work.Method: 323 patients were implanted pacemaker from March, 1999 to March, 2004. 158 patients were implanted physiologic pace markers and 165 patients were implanted nonphysiologic pace markers. Ultrasonic Cardiogram and Holter were made in all patients before operation. And follow-up survey was carried out on 1, 3 and 6 month after operation. The patients' symptom, syndrome, living quality, ECG and Ultrasonic Cardiogram were included. Investigate and analysis the change of atrial fibrillation and cardiac function.Result: Comparing with pre-operation,?Nonphysiologic pacing group: SV decreased (p<0.05) , CO increased significantly (p<0.01) and there was no difference in LVEF, LAD, LVDd after 1 month. LVEF, SV decreased significantly (p<0.01) , CO,LAD,LVDd increased (p<0.05) after 6 months. (2)Physiologic pacing group: LVEF, SV, CO increased (p<0.05), there was no difference in LVDd, LAD after 1 month. LVEF, SV, CO increased significantly (p<0.01) after 6 months.(3)The atrial fibrillation incidence decreased from 33.3% to 10% (p<0.01) in physiologic pacing group and increased from 32.7% to 40.9%(p<0.01) in nonphysiologic pacing group after operation.(4)According to CO, the best left ventricular systolic function would be got when the atrioventricular delay(AVD) was 150ms and ,the optimal AVD was 161 + 24ms. (5)There is no difference between the patients with atrial fibrillation in operation and with sinus rhythm in operation about the impedance , sensing and pacing threshold of the atrial leads.Conclusion: Physiologic pacing was superior to nonphysiologic pacing in improving living quality of patients with sick sinus syndrome. Physiologic pacing made heart keep better contractive and diastolic function improved cardiac function and decreased the incidence of atrial fibrillation. Left ventricular systolic function was affected greatly by AVD of dual-chamber pacing. It would ameliorate the patients'left ventricular function by...