左室收缩功能不良的起搏依赖患者接受心尖起搏与间隔起搏的远期随访研究  

Long-term outcome of right ventricular septal versus apical pacing on left ventricular dysfunction patients with high degree heart block

作　　者：吴冬燕[1] 卢凤民[1] 孙健美[1] 李琼[1] 付乃宽[1] 陈永利[1] 马薇[1] 许静[1] 

机构地区：[1]天津胸科医院心内科,天津300051

出　　处：《中国心脏起搏与心电生理杂志》2014年第2期128-131,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：天津市卫生局重点攻关项目(编号:11KG124)

摘　　要：目的评价右室心尖（RVA）起搏和右室间隔（RVS）起搏对于左室收缩功能不良的患者远期预后的影响。方法33例RVA起搏和26例RVS起搏的患者入选，其左室射血分数（LVEF）在0．36—0．50。根据影像学特点及超声心动图（UCG）检查明确RVS组心室电极位于右室间隔，测量并分析起搏术后1周及术后6个月的心脏结构及双室机械收缩延迟（IVMD）、左室12节段达峰时间标准差（Ts-SD）的变化，随访记录近6年的心力衰竭再入院及心因性死亡事件。结果随访（48．9±5．6）个月，两组患者组间术后1周及6个月的Ts—SD无显著差异，但IVMD有显著差异。术后6个月RVS组LVEF略高于RVA起搏组，RVS组心脏事件及心因性死亡事件发生率低于RVA组（分别为15．4％vs45．5％，3．8％vs9％，P〈0．05），两组死亡率无差异。结论RVS起搏可以减慢左室心功能已经受损的起搏依赖患者的心功能恶化，可能是通过改善双室收缩同步性实现的。Objective To access whether long-term right ventricular septal（RVS） pacing is superior to right ventricular apical（RVA） pacing in high heart block patient with left ventricular dysfunction. Methods Fifty-nine patients （33 with RVS pacing, and 26 with RVA pacing） were recruited, whose left ventricular eject fraction（LVEF） were between 0. 35 and 0.50. Ultrasonic-cardiogram （UCG） confirmed a septal lead position in all patients in the RVS pacing group. Afer 1 week and 6 months following implantation, LVEF, and left ventricular dyssynchrony and inter-ventricular mechanic delay （IVMD） were measured. Result During the long term follow-up, in RVA pacing group, there were 3 patients died, 5 patients upgrade to cardiac resynchronization therapy, 7 patients hospitalization because of heart failure. In RVS pacing group, there were only 4 patient hospitalization because of heart failure. Differences of IVMD were observed between groups. Conclusion Compared with RVA pacing, RVS pacing could improve the outcome of high degree heart block with left ventricular dysfunction. The latter were associated with better inter-ventricular contraction synchrony.

关 键 词：心血管病学 心脏起搏 右室心尖部 右室间隔部 超声心动图 心力衰竭 

分 类 号：R541.61[医药卫生—心血管疾病] R318.11[医药卫生—内科学]