目的：针对房颤和未控制的室速，房室结射频消融术和起搏器置入（消融或起搏）已经被证明为一种有效的治疗，特别是对老年患者而言。研究旨在评估房室结射频消融术后起搏器的依从性和相关临床症状的出现几率。

方法与结果：163名曾接受了消融和起搏器的患者接受了评估。对患者的生活质量，意识损害，中风/一过性缺血，心衰入院率和心悸进行了评估，并通过仪器评价了起搏器抑制期间的起搏器独立性。起搏抑制定义为溢搏，停搏>5s，稳定后搏动<30s。其中132名患者接受了平均36个月的随访，其中19%在评估期内死亡。55名患者为起搏器依从，38名为则有主诉症状，其中19名为头晕，15名出现浅晕厥，4名晕厥，77名患者被认定为非起搏器依从综合症，出现症状的仅为3名。两组间在晕厥，中风/TIA，心衰入院率和生活质量之间无显著性差异。

结论：这一研究证明了消融和起搏对慢性或复发性房颤和未控制的室速是安全有效的治疗手段。

　　（来源： Europace. 2007 Oct 24）

Evaluation of pacemaker dependence in patients on ablate and pace therapy for atrial fibrillation.

Occhetta E, Bortnik M, Dell’era G, Zardo F, Dametto E, Sassone B, Gabrieli L, Marino P.
1Cardiology Division, Azienda Ospedaliera Maggiore della Carità, Corso Mazzini 18, 28100 Novara, Italy.

Aims In patients with atrial fibrillation (AF) and uncontrolled ventricular rate, radiofrequency (RF) ablation of the atrioventricular (AV) node and pacemaker (PM) implantation (ablate and pace) is a valid therapeutic approach, especially in elderly patients. The aim of our study was to evaluate the PM dependence and the incidence of correlated clinical phenomena in a patients population with AV block induced by RF ablation of the AV junction.

Methods and results One-hundred and sixty-three patients (71 men; mean age 71 +/- 8 years) who had undergone ablate and pace therapy were evaluated. The patients underwent assessment of quality of life, impairment of consciousness, stroke/transient ischaemic attack (TIA), hospitalizations for heart failure, episodes of palpitations, and instrumental evaluation of PM dependence during PM inhibition (absence of escape rhythm; asystolic pause >5 s; escape rhythm <30 bpm after rhythm stabilization). Correlation between instrumentally evaluated PM dependence and clinical history was analysed. Hundred and thirty-two patients were evaluated after a mean follow-up period of 36 months [31 subjects (19%) died before the evaluation]; 55 patients (42%) were classified as PM-dependent: 38 (69%) complained of disturbances (19 dizziness, 15 pre-syncope, 4 syncope); 77 patients (58%) were considered non-PM-dependent: symptoms (dizziness, flush) were reported by only 3 (4%). No significant differences emerged between PM-dependent and non-PM-dependent patients with regard to episodes of pre-syncope, syncope, stroke/TIA, hospitalizations for heart failure, and quality of life.

Conclusion This study confirms that ablate and pace is an effective and safe approach in subjects with chronic or recurrent AF and uncontrolled ventricular rate.