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1、IMPLANTABLEDEVICEFORTHETREATMENTOFATRIALFIBRILLATIONAtrialfibrillationisacommonarrhythmiaCommonsymptoms:palpitationsDyspneafatigueAssociatedcomplications:StrokeheartfailuredeathCooperJM,etal.NEJM,2002,346(26):2062-68CommonApproachesRatecontrolplusanticoagulationRhythmcont
2、rolwithantiarrythmicmedicationsPacemakeranddefibrillatorCooperJM,etal.NEJM,2002,346(26):2062-68VentricularpacingduringartrialfibrillationSymptomaticbradycardia-----permanentpacemakersTheatrioventricularnodeisbomdardedwithelectrialimpulsesThefactorsinfluencesonVentricularr
3、ateintrinsicconduction-systemdiseasetakeingrate-controllingpharmacologicagentswithhighavagaltoneCooperJM,etal.NEJM,2002,346(26):2062-68Ablationofatrioventricularnode plusimplantationofpacemaker(1)decreasestheincidenceofpalpitations,dyspnea,etalincreasesexercisetoleranceel
4、minatesrate-controllingmedicationsimprovesthecardiovascularhemodynamicAblationofatrioventricularnode plusimplantationofpacemakerNoeffectonthefibrillationintheatriaNoeffectontheassociatedriskofthromboembolismCooperJM,etal.NEJM,2002,346(26):2062-68适应证症状严重的、药物无效或不能耐受药物治疗的慢性房
5、颤和房扑患者一般均有不同类型的基础病PreventionofatrialfibrillationwithatrialpacingThemechanismofatrialpacingAllowscoordinatedcontractionofthechambersLowersaverageatrialpressureDeacreasesanystretch-relatedchangesPreventspausesandreducestheriskoftheatrialfibrillationassociatedwithincreasedva
6、galtoneandbraycardiaSupressectopicatrialbeatsTheModeSelectionTrialNumberofpatients:Morethan2000patientswiththeSSSTwogroups:ventricularpacemaker,dual-chamberpacemakerTheprimaryendpoints:mortality,strokeResult:nodifferencewithrespecttotheprimaryendpoint;50%decreaseinthelike
7、hoodofafirstepisodeofatrialfibillationandareductioninkiskofprogressiontochronicatrialfibillationwithdual-chamberpacingPressreleaseofNASP,Natick,Mass,May,2001Alternativesingle-siteanddual-siteatrialpaceng房间传导阻滞（InterartrialConductionBlock）一般人群房间传导阻滞发生1%，缓—速综合征患者发生率32%诊断标准：
8、右房与左房间传导超过100ms体表心电图：P波增宽P波时限≥120msⅠ导联P波常有明显切迹，切迹间双峰间距＞0.04Ⅱ、Ⅲ导联P波双向，先负后正Synchronizedatrialactiv
