心室的泵血功能依赖于心室激动顺序,通过正常心脏特殊传导系统下传的电激动引起心室收缩的同步性和泵血功能往往最佳。传统的右心室心尖部起搏类似于左束支传导阻滞,可使QRS时限延长、心室收缩不同步,进而导致心室重构和心功能受损。大约77%的窦房结病变患者的房室传导及室内传导功能良好,如果强制右心室心尖起搏,使心室收缩不同步就可能增加心房颤动、心力衰竭以及死亡的风险。临床研究已经证实AAI/R模式起搏能够获得最佳的临床预后,可减少心房颤动及心力衰竭的风险,但窦房结病变患者可能会出现间歇性房室传导阻滞,仅置入AAI/R单腔起搏器亦存在风险。
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