右室心尖部起搏与右室流出道起搏对Ⅲ度房室传导阻滞患者疗效的对比研究  

A clinical comparison of effectiveness between right ventricular outflow tract pacing and right ventricular apex pacing in patients with complete atrioventricular block

作　　者：侯勃[1] 蔡尚郎[1] 孙品[2] 王茂敬[1] 

机构地区：[1]青岛大学医学院附属医院心内科,山东青岛266003 [2]青岛大学医学院附属医院超声科,山东青岛266003

出　　处：《临床心血管病杂志》2010年第3期184-186,共3页Journal of Clinical Cardiology

摘　　要：目的:比较右室心尖部起搏与右室流出道起搏对Ⅲ度房室传导阻滞患者心室间运动同步性及左室内运动同步性,以及对患者心功能的影响。方法:选取因Ⅲ度及高度房室传导阻滞患者置入双腔起搏器患者共38例。其中心室电极置入右室流出道者20例(RVOT组),置入右室心尖部18例(RVA组),超声心动图术前测量左室舒张末内径(LVEDD),左室收缩末内径(LVESD)、左室射血分数(LVEF)、E/A值、心室间激动延迟时间(IVMD)、室间隔与左心室后壁间收缩延迟时间(SPWMD)。术后1个月、12个月随访。结果:术后1个月,与RVOT组比较,RVA组IVMD、SPWMD明显延长[IVMD(39.83±6.01)∶(31.95±7.86)ms,P=0.02],[SP-WMD(97.83±20.81)∶(84.6±10.89)ms,P=0.023]。术后12个月,与ROVT组比较,RVA组LVEDD明显增大[(49.11±2.39)∶(47.4±1.96)mm,P=0.02],LVESD明显增大[(34.28±3.41)∶(32.5±1.5)mm,P=0.04];LVEF明显降低[(59.56±3.38)∶(62.8±2.14)%,P=0.001],IVMD、SPWMD明显延长[IVMD(48.83±8.42)∶(41.5±11.01)ms,P=0.02],[SPWMD(143.89±12.43)∶(136.45±8.37),P=0.03]。结论:与右室心尖部起搏相比,右室流出道起搏相对减轻患者心脏收缩功能受损及心脏运动不同步。Objective：To compare the effects of right ventricular apex（RVA）pacing and right ventricular outflow tract（RVOT）pacing on synchronization interventricular and intraventricular and left ventrieular（LV）ruction in patients with complete atrioventricular block.Method：Thirty-eight patients with complete atrioventricular block were randomized received RVA or RVOT pacing.Out of 38 patients,18 were received RVA pacing and 20 were received RVOT pacing.Left ventricular end diastolic diameter（LVEDD）,left ventricular end systolic diameter（LVESD）,left ventricular ejection fracction（EF）,E/A,the interventricular mechanical delay（IVMD）and septal to posterior wall motion delay（SPWMD）were measured before operation,1 month and 12 month after implanting,respectively.Result：Compared with the RVOT group,RVA pacing increased IVMD and SPWMD significantly [IVMD（39.83±6.01）∶（31.95±7.86）ms,P=0.02],[SPWMD（97.83±20.81）∶（84.6±10.89）ms,P=0.023].One year after oparation,compared with the RVOT group,RVA pacing increased LVEDD and LVESD[LVEDD（49.11±2.39）∶（47.4±1.96）mm,P=0.02],[LVESD（34.28±3.41）∶（32.5±1.5）mm,P=0.04].RVA pacing decreased LVEF [（59.56±3.38）∶（62.8±2.14）%,P=0.001] and increased IVMD and SPWMD [IVMD（48.83±8.42）∶（41.5±11.01）ms,P=0.02],[SPWMD（143.89±12.43）∶（136.45±8.37）,P=0.03] significantly.Conclusion：Compared with RVOT pacing,RVA pacing induced mechanical dyssynchrony and impairs left ventricular function.

关 键 词：房室传导阻滞 右室流出道起搏 右室心尖部起搏 同步性 起搏器 

分 类 号：R541.7[医药卫生—心血管疾病]