中国心脏起搏与电生理发展现状概况
作者：陈新 王方正 华伟
单位：北京市，中国医学科学院 中国协和医科大学 心血管病研究所 阜外心血管病医院 电生理研究室(100037)
关键词：
心脏起搏与电生理是心脏介入治疗的重要领域 心脏起搏与电生理是心脏介入治疗的重要领域，随着生物医学工程和电子技术的不断发展，与其技术密切相关的心脏起搏与电生理近几年也得到了飞速发展。心脏起搏与电生理技术的广泛应用已对心律失常的治疗产生了深远的影响，对于某些快速心律失常的治疗，已逐渐取代了抗心律失常的药物治疗，不仅如此，对心律失常患者的预后同样产生了影响。1997年，国际上大规模多中心临床试验——埋藏式心率转复除颤器(ICD)与抗心律失常药物对比研究(AVID)得出结论，ICD治疗与抗心律失常药物相比，可明显降低恶性室性心律失常患者的死亡率。并提出ICD应作为恶性室性心律失常治疗的首选。我国近几年来在心脏起搏与电生理方面，也得到了长足的发展。
, http://www.100md.com
心脏起搏方面：1998年，中华医学会心电生理与起搏学会对全国自1995年～1997年3年心脏起搏与埋藏式心律转复除颤的应用情况进行了调查，调查显示：全国永久起搏器置入数量呈较快的增长趋势。自1994年的3 000台左右增至1997年的5 000台左右，每年递增15%以上。估计1998年全国起搏器置入数量已超过6 000台。虽然生理性起搏所占比例逐年增加，但仍然偏低，约占20%左右。随着起搏新技术的不断发展，起搏治疗适应证也不断拓宽，已不仅仅限于缓慢性心律失常的治疗。目前双腔起搏治疗肥厚型梗阻性心脏病；双心房同步起搏治疗阵发性快速房性心律失常，以及最近成为国际上热点的双心室同步起搏治疗充血性心力衰竭，均已在我国开始应用，并取得了良好的疗效。起搏器的一些新的功能如自动工作方式转换，自动阈值夺获等使起搏器功能日趋完善，更符合生理性，在临床上得到越来越广泛的应用。
ICD目前已成为恶性室性心律失常的首选治疗方法。我国自1996年开始应用经静脉胸前置入ICD系统以来，发展较快，至1998年底，已为71例患者置入了ICD。不少大医院已经掌握经静脉置入ICD技术。但由于经济条件的限制以及不少基层医生对ICD这一新的治疗方法认识不够，许多恶性室性心律失常患者还不能够得到ICD的治疗。随着我国经济的不断发展以及ICD技术的不断推广，ICD治疗在不远的将来在我国将进入快速发展阶段。
, 百拇医药
电生理方面：经射频导管消融治疗快速室上性和室性心律失常，在我国已广泛应用，射频导管消融例数已超过2万例，手术成功达到95%。室上性心动过速(SVT)占消融病例的绝大多数，根据阜外心血管病医院统计，SVT中55%为房室旁路折返性心动过速，40%为房室结双径路折返性心动过速，其余为房性心动过速，心房扑动等。射频导管消融治疗快速心律失常种类，由最初的房室旁路和房室结双径路折返性心动过速，扩展到目前特发性室性心动过速，频发室性早搏，房性心动过速，不适合窦性心动过速、心房扑动以及局灶性心房颤动等。随着临床经验的不断积累，手术成功率正不断提高，并发症也越来越少。射频导管消融治疗快速的心律失常，已成为安全、可靠，并发症少，远期疗效确切的治疗方法，已被越来越多的患者所接受。
The State of Cardiac Pacing and Electrophysiology in China
Division of Clinical Electrophysiology, Cardiovascular Institute and Fu Wai Hospital, CAMS and PUMC, Beijing (100037)
, http://www.100md.com
Chen Xin, Wang Fangzheng, Hua Wei.
The Chinese society of cardiac pacing and electrophysiology organized national survey on cardiac pacing in the period from January 1, 1995 to December 31, 1997. There are 182 hospitals all over the country participated in the survey. Following is the result of the survey.
There were a total number of 5 000 new implanted pacemakers in China in 1997. It was increased rapidly (>15%) annually compared with that in 1994 (3 000). There were about 700 pacemakers replacement. It is estimated there were about 6 000 pacemakers implanted in 1998. The single chamber ventricular (VVI) pacing accounted for 79.6% of total pacemaker implantation. However, the percentage of Dual-chamber and rate-responsive pacing is increasing in 1997 (20.4%), compared with that in 1996 (16.1%) and in 1995 (14.5%). The indication for pacemaker implantation was sick sinus syndrome in 50%～53% patients and atrial ventricular block in 41%～44% patients, others in 5%～7% patients from 1995 to 1997. coronary heart disease was found in 50%～57% patients. 66.8% patients were over 60 years old and male was 71.4% in patients received pacing therapy. The new pacing technique, including automatic mode switch, auto capture, mutisite pacing to treat atrial fibrillation and congestive heart failure, have been used in China.
, 百拇医药
Since transvenous Implantable Cardioverter-Defibrillators (ICD) were applied in China in 1996, there are a total of 71 ICD implanted before 1998. All the devices were the third generation ICD included Medtronic Jewel, CPI Vantak series and Pacesetter Angstrom. The mean age of patients was 48.7 years, 61 males and 10 females. Most of them suffered from coronary heart disease and dilated cardiomyopathy. All the patients had syncope out of hospital and ventricular fibrillation was found in 27 patients and ventricular tachycardia was found in other 44 patients. All the implantation were performed in the catheter laboratory without complication.
There are total about 20 000 cases were undertaken catheter ablation in China. The arrhythmias for ablation included supraventricular tachycardia, atrial tochycordia, atrial flutter, focal atrial fibrillation, ventricular ectopic, idiopathic ventricular tachycardia and so on., http://www.100md.com
单位：北京市，中国医学科学院 中国协和医科大学 心血管病研究所 阜外心血管病医院 电生理研究室(100037)
关键词：
心脏起搏与电生理是心脏介入治疗的重要领域 心脏起搏与电生理是心脏介入治疗的重要领域，随着生物医学工程和电子技术的不断发展，与其技术密切相关的心脏起搏与电生理近几年也得到了飞速发展。心脏起搏与电生理技术的广泛应用已对心律失常的治疗产生了深远的影响，对于某些快速心律失常的治疗，已逐渐取代了抗心律失常的药物治疗，不仅如此，对心律失常患者的预后同样产生了影响。1997年，国际上大规模多中心临床试验——埋藏式心率转复除颤器(ICD)与抗心律失常药物对比研究(AVID)得出结论，ICD治疗与抗心律失常药物相比，可明显降低恶性室性心律失常患者的死亡率。并提出ICD应作为恶性室性心律失常治疗的首选。我国近几年来在心脏起搏与电生理方面，也得到了长足的发展。
, http://www.100md.com
心脏起搏方面：1998年，中华医学会心电生理与起搏学会对全国自1995年～1997年3年心脏起搏与埋藏式心律转复除颤的应用情况进行了调查，调查显示：全国永久起搏器置入数量呈较快的增长趋势。自1994年的3 000台左右增至1997年的5 000台左右，每年递增15%以上。估计1998年全国起搏器置入数量已超过6 000台。虽然生理性起搏所占比例逐年增加，但仍然偏低，约占20%左右。随着起搏新技术的不断发展，起搏治疗适应证也不断拓宽，已不仅仅限于缓慢性心律失常的治疗。目前双腔起搏治疗肥厚型梗阻性心脏病；双心房同步起搏治疗阵发性快速房性心律失常，以及最近成为国际上热点的双心室同步起搏治疗充血性心力衰竭，均已在我国开始应用，并取得了良好的疗效。起搏器的一些新的功能如自动工作方式转换，自动阈值夺获等使起搏器功能日趋完善，更符合生理性，在临床上得到越来越广泛的应用。
ICD目前已成为恶性室性心律失常的首选治疗方法。我国自1996年开始应用经静脉胸前置入ICD系统以来，发展较快，至1998年底，已为71例患者置入了ICD。不少大医院已经掌握经静脉置入ICD技术。但由于经济条件的限制以及不少基层医生对ICD这一新的治疗方法认识不够，许多恶性室性心律失常患者还不能够得到ICD的治疗。随着我国经济的不断发展以及ICD技术的不断推广，ICD治疗在不远的将来在我国将进入快速发展阶段。
, 百拇医药
电生理方面：经射频导管消融治疗快速室上性和室性心律失常，在我国已广泛应用，射频导管消融例数已超过2万例，手术成功达到95%。室上性心动过速(SVT)占消融病例的绝大多数，根据阜外心血管病医院统计，SVT中55%为房室旁路折返性心动过速，40%为房室结双径路折返性心动过速，其余为房性心动过速，心房扑动等。射频导管消融治疗快速心律失常种类，由最初的房室旁路和房室结双径路折返性心动过速，扩展到目前特发性室性心动过速，频发室性早搏，房性心动过速，不适合窦性心动过速、心房扑动以及局灶性心房颤动等。随着临床经验的不断积累，手术成功率正不断提高，并发症也越来越少。射频导管消融治疗快速的心律失常，已成为安全、可靠，并发症少，远期疗效确切的治疗方法，已被越来越多的患者所接受。
The State of Cardiac Pacing and Electrophysiology in China
Division of Clinical Electrophysiology, Cardiovascular Institute and Fu Wai Hospital, CAMS and PUMC, Beijing (100037)
, http://www.100md.com
Chen Xin, Wang Fangzheng, Hua Wei.
The Chinese society of cardiac pacing and electrophysiology organized national survey on cardiac pacing in the period from January 1, 1995 to December 31, 1997. There are 182 hospitals all over the country participated in the survey. Following is the result of the survey.
There were a total number of 5 000 new implanted pacemakers in China in 1997. It was increased rapidly (>15%) annually compared with that in 1994 (3 000). There were about 700 pacemakers replacement. It is estimated there were about 6 000 pacemakers implanted in 1998. The single chamber ventricular (VVI) pacing accounted for 79.6% of total pacemaker implantation. However, the percentage of Dual-chamber and rate-responsive pacing is increasing in 1997 (20.4%), compared with that in 1996 (16.1%) and in 1995 (14.5%). The indication for pacemaker implantation was sick sinus syndrome in 50%～53% patients and atrial ventricular block in 41%～44% patients, others in 5%～7% patients from 1995 to 1997. coronary heart disease was found in 50%～57% patients. 66.8% patients were over 60 years old and male was 71.4% in patients received pacing therapy. The new pacing technique, including automatic mode switch, auto capture, mutisite pacing to treat atrial fibrillation and congestive heart failure, have been used in China.
, 百拇医药
Since transvenous Implantable Cardioverter-Defibrillators (ICD) were applied in China in 1996, there are a total of 71 ICD implanted before 1998. All the devices were the third generation ICD included Medtronic Jewel, CPI Vantak series and Pacesetter Angstrom. The mean age of patients was 48.7 years, 61 males and 10 females. Most of them suffered from coronary heart disease and dilated cardiomyopathy. All the patients had syncope out of hospital and ventricular fibrillation was found in 27 patients and ventricular tachycardia was found in other 44 patients. All the implantation were performed in the catheter laboratory without complication.
There are total about 20 000 cases were undertaken catheter ablation in China. The arrhythmias for ablation included supraventricular tachycardia, atrial tochycordia, atrial flutter, focal atrial fibrillation, ventricular ectopic, idiopathic ventricular tachycardia and so on., http://www.100md.com