Clinical Research Of The Prevention Pacing Therapies To Reduce The Arterial Fibrillation Burden

Part One:Clinical Feature of Brady-Tachy Arrhythmia Syndrome Implanted With PacemakerBackgroud:To value the detection of left cardiac structures for the pacemaker planted with brady-tachy arrhythmia syndrome (B.T.S) patients, and evaluate and importance of drug therapy for the ventricular rate control.Method:A total of42brady-tachy arrhythmia patients with normal cardiac function were enrolled. The clinical symptom, history of disease, medications were clearly recorded. The ECG of HR, P wave duration, PR interval, Q.RS complex duration, QT interval, and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and some echocardiographic variables, including left atrial diameter(LAD), LV end-systolic diameter(LVDS), LV end-diastolic diameter(IVDD), interventricular septum thickness(LVST), LV posterior wall thickness(LVPWT)and LVEF were measured. ALL of them were implanted with Vitatron T70A1or C70A3type pacemaker. After3months diagnostic period and3months treatment period, the atrial fibrillation burden was noted by programmer. Relationship between AF burden and echocardiographic variables, NT-proBNP levels as well as the antiarrhythmic drug use would be analysis.Results:1. P wave duration was positively correlated with LAD in B.T.S patients.2. log (NT-proBNP) was highly correlated with AF burden of diagnostic period (r=0.568, p=0.017) and age of patient.3. There is no such relationship between AF burden deviation and ECG and echocardiographic variables, such as HR, P wave duration, PR interval, QRS complex duration, QT interval, LAD, LVDS, LVDD, IVST, PASP and LVEF, as well as NT-proBNP.4. It showed strong relationship between AF burden deviation and regular antiarrhythmic drugs therapy.Conclusion:In B.T.S patients, NT-proBNP level raised with the increase of age and AF burden. And the use of antiarrhythmic drugs therapies effect the prognosis of the disease. Part Two:Effect of Prevention Pacing Therapies to Reduce Atrial Fibrillation in Bradycardia tachycardia Syndrome PatientsBackground:This study was to evaluate the efficacy and safety of the prevention pacing therapies (PPTs) and its personalized activation to reduce the paroxysmal atrial fibrillation (PAF) burden in Bradycardia tachycardia Syndrome Patients.Method:We took self controlled study. Forty-two Brady-tachy arrhythmia syndrome patients were enrolled. The clinical symptom, history of disease, medications, ECG and echocardiographic variables were clearly recorded before and implantation. All of them were implanted with Vitatron T70A1and C70A3type pacemaker. Open the Refined ventricular pacing (RVP) prior to discharge. In3month follow-up (diagnostic period), if one minute before the atrial fibrillation, over70%of the premature atrial beats were more than two, opened all trigger PPTs, or otherwise opened persistent PPTs. Ventricular rate stabilization(VRS) algorithms were also turn on. In the subsequent6months follow-up (treatment period), the data was recorded. Drug treatment remained unchanged. The atrial fibrillation burden was noted by programmer. AF burden deviation (AAF burden)=AF burden in diagnostic period-AF burden in treatment period. Relationship between AF burden and percentage of atrial pacing (AP), ventricular pacing (VP), AF lasting time, heart rate and variability of heart rate when AF occurred would be analysis.Result:1.40patients completed the entire follow-up period, while2patients missed date.12cases showed zero AF burden and1patient developed permanent AF.2. In the AF burden of high group (AF>5%), the AF burden was significantly reduced (8.25%VS22.3%, P=0.0237). AP%was significantly higher in the treatment period then that in the diagnostic one (68.8124.2VS52.4±26.0, P=0.0213). RVP and VRS could help to reduce the variability of ventricular rate when AF occurred (13.7±8.3VS20.4±8.5, P=0.0164), while the same result exist in the AF burden of high group (15.47±6.96VS10.15±5.85, P=0.0119).3. AP%was much higher in the effective group than that in the noneffective group (52.4±23.84%VS71.38±20.25%, p=0.0093), and AV synchronous pacing was also higher than that in the noneffective group (52.4±23.84%VS71.38±20.25%, p=0.0093). the variability of ventricular rate when AF occurred was lower in treatment period than that in diagnostic period in the effective group (19.35+8.59%VS13.22+8.49%, p=0.0304).4. Multiple artial premature contractions and recurrence of AF are the main triggers.5. Multiple regression analysis showed high positive relationship between AAF burden and AP%(r=0.913, P<0.001).Conclusion:The study proved that the dual-chamber pacing can prevent atrial fibrillation. It is effective and safe for bardy-tachy arrhythmia syndrome patients implanted with PPTs pacemakers and personalized PPTs programs to reduce AF burden. The increase of AP%might be helpful to the reduction of AF burden.