右束支旁起搏与右心室心尖部起搏随机对照研究  

Para-right bundle branch pacing and right ventricular apical pacing random comparative study

作　　者：姚瑞[1] 杜优优[1] 陈庆华[1] 张彦周[1] 赵洛沙[1] 李凌[1] 

机构地区：[1]郑州大学第一附属医院心内科,郑州450052

出　　处：《临床心血管病杂志》2014年第11期950-955,共6页Journal of Clinical Cardiology

摘　　要：目的:随机对照研究右束支旁(para-right bundle branch,PRBB)起搏与右心室心尖部(right ventricular apical,RVA)起搏对心脏同步性和心功能的影响,探讨PRBB起搏中的临床意义。方法:40例三度房室传导阻滞伴交界性逸搏患者,随机分为PRBB起搏组和RVA起搏组,其中PRBB起搏组右心室起搏电极在右束支电位标测指引下,将起搏电极固定于PRBB。分别记录术中右心室起搏电极植入X线曝光时间和测试起搏位点次数,术后1d、3个月、6个月和1年测试起搏电极参数,同时测量起搏心电图QRS波时限进行对比分析。术前和术后1年,行超声心动图检查,分别测量左室舒张末内径(left ventricular end-diastolic dimension,LVEDD)、左心室射血分数(left ventricular ejection fraction,LVEF)、心室间机械延迟(interventricular mechanical delay,IVMD)和室间隔-左心室后壁收缩运动延迟时间(septal-to-posteriowall motion delay,SPVMD)进行对比分析。结果:40例患者均成功植入起搏器,无并发症发生。PRBB起搏组与RVA起搏组右室电极导线植入X线曝光时间和尝试位点次数相比分别为:[(28.2±7.9)min∶(2.4±1.9)min,P<0.001]和[(4.5±1.7)次∶(1.4±0.7)次,P<0.001]。右心室起搏电极参数稳定,心室起搏阈值和右束支夺获阈值在术后6个月前有轻微增高趋势(P<0.05),6个月后参数趋于稳定。起搏心电图显示PRBB起搏组QRS波时限明显短于RVA起搏组(P<0.001)。随访1年,与PRBB起搏组相比,RVA起搏组LVEF降低(P<0.05),IVMD和SPVMD明显增加(P<0.05)。结论:通过右束支电位标测指导PRBB起搏电极导线植入安全可行,PRBB起搏较RVA起搏更加符合生理性起搏。Objective：To compare the effects of para-right bundle branch（PRBB）pacing and right ventricular apical（RVA）pacing on left ventricular synchronization and function.Method：Forty patients with three degree atrioventricular block were randomly divided into PRBB group and RVA group.Right ventricular pacing leads of PRBB group were implanted at the region of PRBB by right bundle branch potential mapping.Clinical data,fluoroscopic exposure time for the PRBB pacing leads implantation and testing pacing sites of each patient were collected.Pacing leads parameters and QRS width were measured on 1day,3months,6months and 1year after the operation.Left ventricular end-diastolic dimension（LVEDD）,left ventricular ejection fraction（LVEF）,interventricular mechanical delay（IVMD）and septal-to-posteriowall motion delay（SPVMD）were detected by ultrasonic cardiogram.Result：Forty patients were successfully implanted the pacemakers without complication.Mean fluoroscopic exposure time and attempting pacing sites of PRBB group and RVA group were significantly different（P〈0.001）.The thresholds of pacing ventricle and capture right bundle branch were increasing slightly during first 6months,and thereafter were stable.The QRS wave width of PRBB group was longer than RVA group（P〈0.001）.One year follow-up,LVEF,IVMD and SPVMD of RVA group were poorer than these of PRBB group（P〈0.05）.Conclusion：By means of mapping the right bundle branch potential,the ventricular pacing leads can be screwed at the region of PRBB,and this application is safe and feasible.PRBB pacing is better than RVA pacing.

关 键 词：起搏器 生理性起搏 右束支 

分 类 号：R541.7[医药卫生—心血管疾病]