DDD起搏器植入患者房室顺序下传及右室心尖部起搏模式下左心室功能评估  

Study of left ventricular function in patients with DDD pacemaker implantation during atrioventricular conduction and right ventricular apex pacing mode

作　　者：姚静[1] 许迪[1] 张艳娟[1] 唐欢[1] 谢冰[1] 戴阳[1] 张荣[1] 王惠[1] 雍永宏[1] 吴红平[1] 周蕾[1] 季玲[1] 

机构地区：[1]南京医科大学第一附属医院心脏科,南京210029

出　　处：《中华超声影像学杂志》2016年第2期93-98,共6页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金（81000618,81271589）;六大人才高峰资助项目（2013-WSN-029）

摘　　要：目的分析因病态窦房结综合征（sick sinus syndrome，SSS）行DDD起搏器植入的患者分别在房室顺序下传（atrioventricular conduction，AVC）及右室心尖部起搏（right ventricular apex pacing，RVAP）模式下的心功能参数，探讨DDD起搏器植入患者不同传导／起搏模式对左室收缩功能的影响。方法选择植入DDD起搏器的SSS患者46例，将起搏模式程控于AVC和RVAP模式，选取50例志愿者为对照组。分别测量两种模式下起搏组及对照组左室射血分数（LVEF）、主动脉或肺动脉瓣口脉冲波多普勒（PW）参数，并应用斑点追踪成像技术分别测量各组左室扭转参数。记录起搏器植入患者起搏器植入时间、心室起搏累积百分比（cumulative ventricular pacing proportion，Cum％ VP），并与上述参数进行相关性分析。结果与对照组比较，AVC、RVAP模式下左室扭转角度峰值、心尖旋转角度峰值减低（P均〈0．01），而心底部旋转角度在各组间差异无统计学意义；AVC模式下左室心底-心尖旋转角度达峰时间差无显著改变，而RVAP模式下该参数延长（P〈0．05）。RVAP模式下LVEF较对照组降低（P〈0．05），AVC模式下LVEF与正常对照组比较差异无统计学意义。左室扭转角度峰值与LVEF呈正相关，与Cum％ VP呈负相关。结论右室心尖部起搏可导致心功能降低，这一效应独立于右室心尖部位起搏导致的心肌运动失同步的影响；左室扭转角度、左室心尖部旋转角度较LVEF能更敏感地反映起搏器植入患者的心功能变化；左室扭转角度与Cum％ VP呈负相关。Objective To compare the left ventricular function parameters of patients with sick sinus syndrome （SSS） and DDD pacemaker implantation during atrioventricular conduction （AVC） and right ventricular apex pacing （RVAP） mode. Methods Forty-six consecutive patients with SSS who had undergone DDD pacemaker implantation were studied. Fifty volunteers were included as control group. Changing from AVC to RVAP mode, the acute effect on echocardiographic parameters, including LVEF, parameters of aortic/pulmonary artery pulse wave Doppler, and parameters of left ventricular twist by speckle tracking imaging were measured respectively. Pacemaker implantation duration and cumulative ventricular pacing proportion （Cum% VP） were recorded. The relationships of pacemaker parameter and above left ventricular function parameters were analyzed. Results Compared with control group,values of peak rotation in LV apex and LV twist were significantly lower during AVC and RVAP mode. The value of peak rotation in LV base showed no significant difference between three groups. Apical-basal rotation delay during RVAP was significantly longer than those during AVC and in control group respectively （ P〈 0.05）. LVEF during RVAP decreased statistically （P〈0.05）, but showed no difference during AVC, compared with the control group. The peak LV twist related positively with LVEF, and negatively with Cum% VP. Conclusions RVA pacing decreases left ventricular function, which is independent of asynchrony contraction patterns caused by pacing. LVEF, apical rotation and LV twist are more sensitive to demonstrate the LV dysfunction in patients with pacemaker implantation. LV twist related negatively with Cum% VP.

关 键 词：超声心动描记术 病窦综合征 心脏起搏 人工 心室功能 左 扭转 

分 类 号：R541.7[医药卫生—心血管疾病]