右心室不同部位起搏对P波离散度及阵发性心房颤动发生率的影响  

Effects of pacing at different parts of right ventricle on P-wave dispersion and incidence of paroxysmal atrial fibrillation

作　　者：邹光新 林智海[1] 王正东[1] 甘剑挺[2] 刘明[1] ZOU Guang-xin;LIN Zhi-hai;WANG Zheng-dong;GAN Jian-ting;LIU Ming(Department of Cardiology,Yulin First People＇s Hospital,Yulin 537000,Guangxi,CHINA;Department of Cardiology,Guangxi Zhuang Autonomous Region People ＇s Hospital,Nanning 530021,Guangxi,CHINA)

机构地区：[1]玉林市第一人民医院心血管内科,广西玉林537000 [2]广西壮族自治区人民医院心血管内科,广西南宁530021

出　　处：《海南医学》2018年第14期1944-1947,共4页Hainan Medical Journal

基　　金：广西玉林市科学研究与技术开发计划项目(编号:2015020010)

摘　　要：目的比较右室心尖部(RVA)起搏与右室流出道(RVOT)间隔部起搏对接受起搏器植入治疗的患者的P波离散度(Pd)、阵发性心房颤动(PAF)发生率的影响,探讨较好的右室起搏部位。方法选取2014年1月1日至2015年7月1日在玉林市第一人民医院行永久起搏器植入术的患者62例,根据右心室起搏部位的不同,将患者分为RAV组(24例)和RVOT组(38例),分别在术前、术后6个月、12个月和24个月行12导联体表心电图检查,记录Pd值,并观察在随访过程中PAF发生的情况。结果术前RAV组患者的Pd值为(27.69±5.96)ms,与RVOT组的(28.95±5.14)ms比较,差异无统计学意义(P>0.05),而RVA组在术后6个月、12个月及24个月的Pd值分别为(36.47±7.72)ms、(41.04±7.00)ms和(44.42±5.57)ms,均大于术前,差异均有统计学意义(P<0.05);RVOT组患者在术后6个月、12个月及24个月的Pd值分别为(31.36±4.99)ms、(34.31±4.43)ms和(36.42±4.37)ms,也均大于术前,差异均有统计学意义(P<0.05);而RVA组术后6个月、12个月及24个月Pd值增量的变化均大于RVOT组[(36.47±7.72)ms vs(31.36±4.99)ms,(41.04±7.00)ms vs(34.31±4.43)ms,(44.42±5.57)ms vs(36.42±4.37)ms],差异均具有统计学意义(P<0.05);随访24个月后,RVA组患者的PAF发生率为16.7%,高于RVOT组的7.9%,但差异无统计学意义(P>0.05)。结论右心室起搏可影响心房电活动,但是相对于RVA起搏,RVOT起搏的影响会更小。Objective To explore the better location of right ventricular pacing by comparing the effect of right ventricular apical（RVA） pacing and right ventricular outflow tract（RVOT） pacing on P-wave dispersion（Pd） and paroxysmal atrial fibrillation（PAF） in patients undergoing pacemaker implantation. Methods A total of 62 cases of patients with permanent pacemaker implantation, who admitted to Yulin First People＇s Hospital from January 1, 2014 to July 1,2015, were selected and divided into the group RAV（24 cases） and group RVOT（38 cases） according to the different parts of the right ventricular pacing. Before operation, 6 months, 12 months and 24 months after operation, the electrocardiogram（ECG） of 12 leads was checked, and the Pd value was recorded. The occurrence of PAF during follow-up was observed. Results The Pd value of the group RAV before operation was（27.69±5.96） ms, compared with（28.95±5.14） ms in the group RVOT（P〉0.05）. The Pd values of the group RVA at 6 months, 12 months and 24 months after operation were（36.47±7.72） ms,（41.04±7.00） ms,（44.42±5.57） ms, respectively, which were all significantly more than those before operation（P〈0.05）. The Pd values of patients in the group RVOT at 6 months, 12 months and 24 months after operation were（31.36±4.99） ms,（34.31±4.43） ms,（36.42±4.37） ms, respectively, which were all significantly more than those before operation（P〈0.05）. The changes in Pd increments in the group RVA were（36.47 ± 7.72） ms,（41.04 ± 7.00） ms,（44.42±5.57） ms, respectively, which were greater than corresponding（31.36±4.99） ms,（34.31±4.43） ms,（36.42±4.37） ms in the group RVOT at 6 months, 12 months and 24 months after operation（P〈0.05）. After 24 months of follow-up, the incidence of PAF was 16.7% in the group RVA versus 7.95 in the group RVOT（P〉0.05）. Conclusion Right ventricular pacing can affect atrial electrical activity, but the effect of RVOT pacing is less than RVA pa

关 键 词：右室流出道起搏 右室心尖部起搏 P波离散度 阵发性心房颤动 

分 类 号：R541.75[医药卫生—心血管疾病]