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Fortbestehen des AAI(R)-Modus zum Austauschzeitpunkt

Maintenance of AAI(R) mode at the time of generator replacement

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Beim isolierten Sinusknotensyndrom wird die alleinige Vorhofstimulation empfohlen. Diese schließt jedoch das Risiko einer sich im Verlauf entwickelnden AV-Leitungsstörung mit bedrohlichen ventrikulären Bradykardien mit ein. Diese Möglichkeit führt häufig dazu, dass von vornherein eine zusätzliche Ventrikelelektrode implantiert wird.

Patienten und Methode

In dieser monozentrischen retrospektiven Analyse der Schrittmacheroperationen der Jahre 1982 bis 2007 fanden sich bei 6309 antibradykarden Erstimplantationen zehn Prozent (n=631) AAI- bzw. AAIR-Schrittmacher bei Sinusknotensyndrom. In diesen 26 Jahren erfolgten bei den AAI(R)-Patienten 139 Eingriffe mit Wechsel des Impulsgebers und/oder des Schrittmachermodus, wobei eine erneute Abschätzung des optimalen Stimulationsmodus erfolgte.

Ergebnisse

In 80,6% (n=112) blieb es weiterhin bei AAI(R), in 10,1% (n=14) erfolgte eine Aufrüstung auf DDD(R) während in 9,3% (n=13) auf VVI(R) umgerüstet wurde. Die Schrittmacherlaufzeiten bis zu diesem Eingriff unterschieden sich mit 7,9 gegenüber 6,3 bzw. 7,0 Jahren nicht deutlich.

Schlussfolgerung

Die alleinige Vorhofstimulation beim Sinusknotensyndrom ist auch im Langzeitverlauf zumeist sicher. Ein vorzeitiger Wechsel des Stimulationsmodus ist selten erforderlich.

Abstract

Background

In isolated sinus node disease single lead atrial stimulation is recommended. However, an inherent risk includes emerging AV node disturbances with serious bradycardia in the follow-up. This possible scenario frequently results in the implantation of an additional ventricular lead.

Patients and methods

In this single-centre retrospective study the interval between 1982 and 2007 was analysed. During this period a total of 6,309 antibradycardia pacemakers were implanted for the first time. Ten percent (n=631) of these devices were single lead atrial pacemakers for treatment of the sick sinus syndrome (SSS). In these 26 years 136 pacemaker replacement operations were performed. During this procedure a thorough reevaluation of the stimulation mode was done.

Results

In 80.6% (n=112) AAI(R) was continued, in 10.1% (n=14) the system was upgraded to DDD(R), and in 9.3% the mode was changed to VVI(R). There were no significant differences in the lifetime of the AAI(R) pacemakers up to the time of this operation: 7.9 vs 6.3 vs 7.0 years.

Conclusion

The single lead atrial pacing mode in SSS is mostly safe also in the long term. A premature change of stimulation mode is rarely necessary.

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  1. Weimarische Straße 9, 01127, Dresden, Deutschland

    E. Wunderlich, H. Schindler, A. Hetze & C. Wunderlich

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  1. E. Wunderlich
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Wunderlich, E., Schindler, H., Hetze, A. et al. Fortbestehen des AAI(R)-Modus zum Austauschzeitpunkt. Herzschr. Elektrophys. 21, 196–199 (2010). https://doi.org/10.1007/s00399-010-0104-z

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