右心室流出道间隔部起搏与右心室心尖部起搏随机对照研究  

Right ventricular outflow tract septum pacing and right ventricular apical pacing random comparative study

作　　者：陈泗林[1] 林纯莹[1] 费洪文[1] 刘烈[1] 陈东骊[1] 梁远红[1] 吴书林[1] 

机构地区：[1]广东省人民医院广东省心血管病研究所广东省医学科学院,广州510100

出　　处：《中华心律失常学杂志》2009年第4期253-257,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：广东省重点攻关项目（2006B36007014）;广东省医学科研基金（A2007047）;广东省自然科学基金（7001120）

摘　　要：目的应用组织多普勒方法随机对照研究右心室流出道间隔部（right ventficular outflow tract septum，RVOTS）起搏与右心室心尖部（fight ventricul arapical，RVA）起搏心脏同步性和心功能变化，探讨右心室流出道间隔部在主理性起搏中的临床意义。方法128例缓慢心律失常患者按单双数字随机分为两组，对病态窦房结综合征房室功能正常患者，起搏器植入术后根据心电图PR间期时间将起搏器AV间期调整，暂时关闭AV搜索功能以保证心室起搏。所有患者起搏器植入术后1、3、6个月定期随访，观察起搏参数、累积心室起搏百分比，同时行超声心动图检查。结果RVOTS起搏组与RVA起搏组电极导线植入时间、X线曝光时间差异有统计学意义（P〈0．01），主动固定电极导线植入15min与植入即刻比较起搏阈值明显下降，分别为（0．76±0．21）mV和（1．13±0．25）mV（P〈0．01）。RVOTS起搏组和RVA起搏组QRS时限分别为（0．14±0．04）S、（0．16±0．03）S（P〈0．01）。随访6个月起搏参数两组之间差异无统计学意义。全部患者未出现植入并发症，随访6个月无电极导线移位、阈值增高。6个月RVOTS起搏组左心室同步指标明显优于RVA起搏组（P〈0．01）。左心室收缩末内径及舒张末内径两组比较无显著变化，左心室射血分数在RVA起搏组有所降低（P〈0．05），心脏做功指数（Tei）、RVOTS起搏组与RVA起搏组比较差异有统计学意义（P〈0．05），在RVA起搏组随访6个月与1个月比较差异有统计学意义（P〈0．01）。结论RVA起搏导致心脏收缩不同步，损害左心室功能。RVOTS起搏保持良好心脏收缩同步性、保护左心室功能，是较好的右心室起搏部位。Objective To compare the effects of right ventricular outflow tract septum （RVOTS） pacing and fight ventricular apex （RVA） pacing on left ventricular synchronization and cardiac function by tissue Doppler image. Methods One hundred and twenty-eight patients with bradyarrhythmia were randomly divided into two groups （ RVOTS group and RVA group）. In the sinus sick syndrome patients with normal atrial-ventricle conduction, AV durations were prolonged according to PR duration of ECG and close AV search function in order to ensure ventrieular pacing after implantation. All patients were regularly followed up on clinic 1~t month,3r＇l month and 6＇h month after pacemaker implantation,including pacing parameter,accumulative ventric- ular pacing percentage and echocardiogram. Results The duration of electrode implantation and duration of X- ray exposure in ROVTS group and RVA group were significantly different respectively （ P 〈 0. 01 ）. Pacing threshold after active fixed electrodes decreased compared with that at time of implantation （1.13 ±0. 25） mV vs. （0. 76 ±0. 21 ） mV, （ P 〈 0. 01 ）. QRS durations in RVOTS group and RVA group were （0. 14 ± 0.04 ） s and （0. 16± 0. 03 ） s （P 〈 0. 01 ）. There were no differences in pacing parameter between the two groups in 6 months follow-up. All patients had not suffered from implantation complications and there were also no elec- trodes displacement and increasing of pacing threshold. After 6 months,left ventricular synchronization parame- ters behaved better in RVOTS groups than those in RVA groups（P 〈0. 01 ） ;LVEDD and LVESD manifested no significant change （ P 〉 0. 05 ） ; LVEF significantly decreased in the RVA group （ P 〈 0. 05 ） ; Tei index was significantly different between RVOTS and RVA group. （P 〈 0. 05 ）. In RVA group, Tei index changed signifi- cantly on 6th months than those on 1st month（P 〈 0. 01 ）. Conclusions RVA pacing results in ventricular resynchronization and left ventricular func

关 键 词：右心室流出道间隔部 起搏 超声心动图 组织多普勒 

分 类 号：R541.7[医药卫生—心血管疾病]