右心室心尖部与间隔部起搏对患者心功能的远期影响  

Comparison of long-term effects on cardiac function of right ventricular septal pacing versus right ventricular apical pacing

作　　者：彭珍云[1] 向力群[1] 曾向辉[1] 张良[1] 钟常青[1] 刘振芳[1] 张翼[1] 

机构地区：[1]湖南师范大学第一附属医院心内科,长沙410005

出　　处：《中国介入心脏病学杂志》2013年第2期88-92,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨右心室心尖部与间隔部起搏对长期起搏依赖患者心功能的远期影响。方法入选在湖南师范大学第一附属医院就诊并行双腔起搏器植入术的Ⅲ度房室传导阻滞108例,据心室电极固定部位分为间隔部起搏组(RVS组,57例)及心尖部起搏组(RVA组,51例);比较两组患者术前与术后3年血清氨基末端脑钠肽前体(NT-proBNP)浓度及左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)变化、左心房大小(LA)及心电图Ⅱ导联QRS波时程变化。对NT-proBNP水平与LA及QRS波时程进行直线相关分析。结果术前NT-proBNP浓度、QRS波时程及LA大小两组间差异无统计学意义(P>0.05)。术后两组患者NT-proBNP浓度、QRS波时程及LA大小均较术前明显增大,差异有统计学意义(P<0.05),但心尖部起搏组各观察指标值上升幅度较大。RVA组与RVS组比较显示,NT-proBNP浓度升高更明显[(367.4±38.5)pg/ml比(210.4±36.7)pg/ml,P<0.05];QRS波时程延长[(0.192±0.042)s比(0.151±0.091)s,P<0.05];LA明显扩大[(32.9±4.1)mm比(28.9±4.2)mm,P<0.05]。组内及组间比较,LVEF及LVEDD差异均无统计学意义。双变量直线相关分析显示,NT-proBNP与QRS波时程呈直线正相关(r=0.701);与LA大小呈直线正相关(r=0.671)。结论心尖部起搏易引起心室收缩失同步及左心房不良重构,间隔部起搏更接近生理性起搏,是相对理想的起搏部位。Objective To investigate and compare the efficiency of right ventricular apical pacing （RVA） with right ventricular septal pacing （RVS）. Methods A total of one hundred and eight consecutive patients with Ⅲ atrio-ventricular block （ Ⅲ° AVB） and normal ejection fraction undergoing dual-chamber pacemaker implantation were randomly divided into right ventricular apical pacing group （RVA, n = 51 ） and right ventricular septal pacing group （RVS, n = 57） according to the pacing electrode＇ s position in the right ventricular apex. At baseline and 3-year after pacemaker implantation, the serum N- terminal brain natriuretic peptide （NT-proBNP） level was measured and left ventricular ejection fraction （LVEF） , end-diastolic diameter （LVEDD） and the size of the left atrium were assessed by two-dimensional echocardiography, QRS duration of lead II was recorded between the two groups. The serum NT-proBNP level, QRS duration of lead II and the size of the LA were analyzed by bivariate linear regression. Results There was no difference, among all the parameters at baseline. The two goups both had higher serum NT- proBNP level, longer QRS duration of lead lI and notably enlarger left atrium compared the baseline with 3- year of follow-up （ P 〈 0. 05 ）. But the changes of these parameters were more obvious in the RVA group. The RVA group had higher serum NT-proBNP level [ （ 367.4 ± 38. 5 ） pg/ml vs. （ 210. 4 ± 36. 7 ） pg/ml, P 〈 0.05], prolonged QRS duration of lead 1I [（0. 19 ±0.04） s vs. （0. 15 ±0.09）s,P 〈0.05] and notably larger left atrium [ （32. 9 ±4. 1）mm vs. （28.9 ±5.0）mm,P 〈0. 05] compared to the RVS group at 3-year of follow-up. Bivariate linear regression analysis showed that the serum NT-proBNP level was positively correlated with both the QRS duration of lead II （r = 0. 701 ）and the size of LA （r = 0. 610）. Conclusions RVA was associated with increased dyssynchrony and adverse reconstruction of left atrium compared to the RVS. Ther

关 键 词：房室传导阻滞 心脏起搏 人工 心室功能 心房功能 

分 类 号：R654.2[医药卫生—外科学]