不同起搏方式对高右室起搏比例患者心功能及心房颤动的影响  

Impact of different pacing sites on cardiac function and atrial fibrillation in patients with high right ventricular pacing proportion

作　　者：周建龙[1] 陆敏[1] 朱宗成[1] 朱天哲[1] 盛晓东[1] 范韬[1] 金骁琦[1] 

机构地区：[1]常熟市第二人民医院心内科,江苏215500

出　　处：《国际心血管病杂志》2014年第6期409-411,共3页International Journal of Cardiovascular Disease

基　　金：常熟市卫生局资助项目(CS:201115)

摘　　要：目的:探讨不同起搏部位对高右室起搏比例、缓慢性心律失常患者新发心房颤动(AF)及心功能的影响。方法:入选我院心内科2005年1月至2011年1月期间置入DDD永久起搏器的缓慢性窦房结功能失调或Ⅱ度以上房室传导阻滞患者,选择其中高右室起搏比例者(右室起搏累积百分比>50%)共120例,随机分为右室心尖部(RVA)起搏组(n=47)及右室间隔部(RVS)起搏组(n=73)。随访内容包括起搏器置入术前、术后3年AF发生情况和超声心动图参数。结果:随访期间RVA组新发AF患者比例高于RVS组(23.40%对16.43%,P=0.03)。术后3年,与RVA组相比,RVS组左房内径(LAD)、左室舒张末期内径(LVEDD)明显缩小,左室射血分数(LVEF)则明显升高(P<0.05)。结论:对于DDD起搏模式下高右室起搏比例患者,与RVA起搏相比,RVS起搏可显著改善患者心功能,减少AF的发生。Objective：To evaluate the impact of different pacing sites on cardiac function and atrial fibrillation （AF） in patients with high right ventricular pacing proportion and bradyarrhythmia. Methods： A cohort of 120 patients with high right ventricular pacing proportion diagnosed as chronic sinus node dysfunction or second-degree or above atrioventricular block from January 2005 to January 2011 were enrolled in this study. They were randomly divided into right ventricular septum （RVS）pacing group （n = 47）and right ventrieular apex （RVA） pacing group（n = 73）, and all patients were implanted with permanent DDD pacemaker. The occurrence of AF and eehocardiographie parameters of all patients were recorded during follow-up. Results：The proportion of patients with new onset AF in RVA pacing group was higher than that in RVS pacing group （23.40% vs. 16.43%, P = 0.03）. Compared with RVA pacing group, left atrial diameter and left ventricular end diastolic diameter in RVS pacing group were significantly decreased, while LVEF was increased in RVS pacing group（P〈0.05）. Conclusion： Compared with RVA pacing, RVS pacing can significantly improve cardiac function and reduce the incidence of AF for patients with high right ventricular pacing proportion.

关 键 词：室间隔起搏 心尖部起搏 心律失常 

分 类 号：R541.7[医药卫生—心血管疾病]