Ⅲ度房室传导阻滞患者行右室流出道间隔部与右室心尖部起搏的对照研究  

The control study of pacing at right ventricular apex and right ventricular outflow tract septum in patients with third degree AV block

作　　者：王秋林[1] 周鹏[1] 蔡国才[1] 蒋利成[1] 李璐[1] 杨震[1] 蒲静[1] 李文章[1] 

机构地区：[1]成都医学院第一附属医院心内科,四川成都610500

出　　处：《西部医学》2011年第3期432-435,共4页Medical Journal of West China

摘　　要：目的观察右心室不同部位起搏对Ⅲ度房室传导阻滞行起搏器置入患者心功能的影响。方法 45例行双腔起搏器置入的Ⅲ度房室传导阻滞患者,按心室电极固定部位分右室心尖部(RVA)起搏组和右室流出道间隔部(RVOTS)起搏组,于术后3、12以及24个月末对两组患者行超声心动图检查、采血测血浆B型钠尿肽(BNP)以及行6分钟步行距离(6MHW)测试。结果术后随访3个月时,两组超声心动图检查结果无统计学差异,两组患者BNP水平均无>400 pg/ml者,6MHW亦无明显差异。术后12个月时,RVA组左室舒张末期内径(LVEDD)较术后3个月时增大(P>0.05),LVEF较术后3个月时下降(P>0.05),术后24个月,这种差异更明显(P<0.05)。但RVOTS组的LVEF以及LVEDD在术后12个月以及24个月时与术后3个月时无明显差异(P>0.05)。术后24个月时,RVA组BNP>100 pg/ml者9例,而RVOTS组中只有1例,而术后24个月时RVA有2例患者BNP>400 pg/ml,但RVOTS组无患者BNP>400 pg/ml。在术后24个月时,RVA组患者6MHW较术后3个月时明显减少,而RVOTS组患者却明显增加(P<0.05)。结论右室流出道间隔部起搏安全、有效,比右心室心尖部起搏更有利于双心室电激动的同步性,避免心功能的恶化。Objective To observe the long-term impact of pacing at right ventricular apical（RVA） and right ventricular outflow tract septal（RVOTS） sites on left ventricular function and exercise capacity in patients with third degree AV block.Methods 45 patients with third degree AV block were undergone RVA pacing（n=22） or RVOTS pacing（n=23）.After implanted DDD pacemaker,all patients underwent 6 min hall walk（6MHW） to assess exercise capacity at 3,12,and 24 months,ultrasonic cardiography（UCG） to determine left ventricular function,included left ventricular ejection fraction（LVEF）,and 1eft ventricular end-diastolic diameter（LVEDD） at 3,12,and 24 months,blood plasma brain natriuretic peptide（BNP） to assess heart failure status.Results 3 months after treatment,6MHW,LAD,LVEDD,LVEF,and BNP were comparable in patients with RVA and RVS pacing（P0.05）.24 months after treatment,compared with that of at 3 months,patients with RVA pacing had significant decreases in LVEF and 6MHW（P0.05）,had significant increases in LVEDD（P0.05）,whereas RVOTS pacing preserved LVEF and improved 6MHW（P0.05）.24 months after treatment,there were more patients with RVA pacing whose BNP level is above 100 pg/ml than that with RVOTS pacing（9 vs.1）.Conclusion In patients with third degree AV block,RVOTS pacing is as safe and efficient as RVA pacing,and pacing at RVOTS,but not at RVA,is more beneficial to the biventricular electrical synchronism and preserves LVEF and provides incremental benefit for exercise capacity.

关 键 词：右室流出道间隔部起搏 右室心尖部起搏 左室射血分数 左室舒张末期内径 6分钟步行距离 

分 类 号：R541.7[医药卫生—心血管疾病]