右心室起搏电极位置对心脏再同步化治疗老年慢性心力衰竭临床效果的影响  

Effect of right ventricular pacing electrode position on the efficacy of cardiac resynchronization therapy in elderly patients with chronic heart failure

作　　者：尹微 陈学颖 许铎 季伟敏 王宝珠[4] YIN Wei;JI Wei-min(Department of Cardiovascular Medicin;XU Duo.ICU,Suzhou Science ＆ Technology Town Hospital（Suzhou Hospital Affiliated to Nanjing Medical University）,Suzhou 215153,China;CHEN Xue-ying.Department of Cardiovascular Medicine,Zhongshan Hospital Affiliated to Fudan University,Shanghai 200032,China;WANG Bao-zhu.Department of Cardiovascular Medicine,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]苏州科技城医院(南京医科大学附属苏州医院)心血管内科,江苏省苏州市215153 [2]复旦大学附属中山医院心血管内科,上海市200032 [3]苏州科技城医院(南京医科大学附属苏州医院)重症医学科,江苏省苏州市215153 [4]新疆医科大学第一附属医院心血管内科,新疆维吾尔自治区乌鲁木齐830054

出　　处：《实用老年医学》2018年第11期1019-1022,共4页Practical Geriatrics

摘　　要：目的探讨不同右心室起搏电极位置对心脏再同步化治疗(CRT)老年慢性心力衰竭临床效果的影响。方法选择接受CRT的老年慢性心力衰竭病人84例,术中左室起搏电极位置为侧后壁者65例,非侧后壁者19例,根据术中右室起搏电极位置为右心室流出道间隔(RVOT)和右心室心尖部(RVA)分为RVOT组(n=34)和RVA组(n=50),比较各组病人治疗前后QRS波时限(QRSd)、纽约心脏病协会(NYHA)心功能分级以及心脏超声指标左室射血分数(LVEF)、左心室舒张末期内径(LVEDD)及左心室收缩末期内径(LVESD)的变化。结果RVA组LVEF显著高于RVOT组(P<0.05),NYHA分级、QRSd、LVEDD、LVESD在2组间差异均无统计学意义(P>0.05)。左心室起搏电极在侧后壁者中,RVA亚组LVEF显著高于RVOT亚组(P<0.05),NYHA分级显著低于RVOT亚组(P<0.05),QRSd、LVEDD、LVESD在2组间差异均无统计学意义(P> 0.05)。在非侧后壁者中,RVA亚组与RVOT亚组各指标差异均无统计学意义(P>0.05)。RVA组和RVOT组病人CRT有效率的差异均无统计学意义(P>0.05)。结论 CRT对老年慢性心力衰竭的疗效受双室起搏位置的综合影响,右心室RVA起搏可能较RVOT起搏更具有临床优势,尤其是对于左心室为侧后壁起搏者,将右心室电极置于RVA有利于获得更好的疗效。Objective To study the clinical effect of different location of the right ventricular pacing electrode on the efficacy of cardiac resynchronization therapy（CRT） in the elderly patients with chronic heart failure.Methods A total of 84 elderly patients with chronic heart failure treated with CRT were selected,including 65 cases and 19 cases whose left ventricular pacing electrode position were respectively at posterior wall or not at posterior wall.According to the position of right ventricular pacing electrode,the patients were divided into right ventricular outflow tract septum（RVOT） group（n=34）and right ventricular apex（RVA） group（n=50）.The QRS wave duration（QRSd）,cardiac function（NYHA classification）,left ventricular ejection fraction（LVEF）,left ventricular end diastolic diameter（LVEDD） and left ventricular end systolic diameter（LVESD） were observed and compared before and after treatment among different groups.Results The level of LVEF in RVA group was significantly higher than that in RVOT group（P〈0.05）,while there were no significant differences in NYHA classification,QRSd,LVEDD and LVESD between the two groups（P〉0.05）.Among the patients whose left ventricular pacing was at the posterior wall,the level of LVEF was significantly higher and NYHA grade was significantly lower in RVA subgroup than those in RVOT subgroup（P〈0.05）,while there were no significant differences in QRSd,LVEDD,and LVESD between the two groups（P〉0.05）.Among the patients whose left ventricular pacing were not at posterior wall,the above indexes showed no statistically significant difference between RVA subgroup and RVOT subgroup（P〉0.05）.There was no significant difference in the effective rate of CRT between RVA group and RVOT group（P〉0.05）.Conclusions The efficacy of CRT in treating senile chronic heart failure is affected by the position of biventricular pacing.RVA pacing position may have more clinical advantages compared to RVOT pacing,especially for the patien

关 键 词：右心室起搏电极位置 左心室起搏电极位置 心脏再同步化治疗 慢性心力衰竭 老年人 

分 类 号：R541.61[医药卫生—心血管疾病] R454[医药卫生—内科学]