超声心动图指导双腔起搏患者房室间期优化的研究  

Optimization of atrio-ventricular delay in patients with dual-chamber pacemaker by echocardiography

作　　者：李丽娜[1] 刘佳[1] 张姝兰[1] 强佳琪 董敬[1] 岳庆雄[1] LI Li’na;LIU Jia;ZHANG Shulan;QIANG Jiaqi;DONG Jing;YUE Qingxiong(Department of Ultrasound,Dalian Central Hospital,Liaoning 116033,China)

机构地区：[1]辽宁省大连市中心医院超声科,116033

出　　处：《临床超声医学杂志》2022年第3期186-191,共6页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨超声心动图指导双腔起搏患者优化房室间期的应用价值。方法选取因Ⅲ度房室传导阻滞植入双腔起搏器的患者80例,40例于超声心动图指导下进行房室间期优化(优化组),40例保持出厂默认的房室间期设置不变(非优化组)。于起搏器植入术后3个月(观察基点)行食管心电图检查,测量两组房间传导时间、心房感知心室起搏的房间传导时间、双腔起搏的房间传导时间及室间传导时间;比较观察基点及术后6、12、18个月超声心动图参数的差异;分析最佳左房室间期与心率的相关性。记录两组随访期间并发症发生情况。结果优化组优化后起搏房室间期和对应的左房室间期均较优化前明显延长[(162.5±21.3)ms vs.150.0 ms,(131.5±11.9)ms vs.(120.7±14.7)ms],差异均有统计学意义(均P<0.05);优化后感知房室间期和对应的左房室间期与优化前比较差异均无统计学意义[(125.0±22.6)ms vs.120.0 ms,(128.8±12.2)ms vs.(123.6±16.8)ms]。优化组优化后有效舒张时间较优化前明显延长[(505.8±80.9)ms vs.(352.7±68.6)ms],差异有统计学意义(P<0.05)。优化组术后6、12、18个月左室整体纵向平均应变、有效舒张时间均高于非优化组,术后12、18个月左房容积指数均低于非优化组,术后18个月左室舒张末期容积、左室射血分数均高于非优化组,左室收缩末期容积、二尖瓣口舒张早期血流峰值流速与二尖瓣环室间隔侧舒张早期运动速度的比值均低于非优化组,差异均有统计学意义(均P<0.05)。优化组心率与最佳左房室间期呈负相关(r=-0.911,P=0.000)。优化组术后12、18个月新发心房颤动比例均低于非优化组,差异均有统计学意义(均P<0.05)。结论应用超声心动图指导个体化房室间期优化可以改善因Ⅲ度房室传导阻滞植入双腔起搏器患者的左室舒缩功能,减少或延迟房颤的发生,具有较好的临床应用价值。Objective To investigate the application value of echocardiography guided the setting of atrio-ventricular delay(ADV)in patients with dual-chamber pacemaker.Methods Eighty patients withⅢdegree atrioventricular block after dual chamber pacemaker implantation were divided into two groups.Forty AVDs optimized patients(optimized group)were programmed under the guidance of echocardiography,while 40 patients in the non-optimized group were programmed by default AVD setting.All patients were examined and compared by echocardiography at baseline(3 months after surgery)and 6,12,18 months after surgery.The interatrial conduction time,interatrial conduction time for atrial-aware ventricular pacing,interatrial conduction time with dual-chamber pacing and interventricular conduction time were measured at baseline(3 months after surgery)by esophageal electrocardiogram,and the differences of echocardiographic parameter at baseline,6,12,and 18 months after surgery were compared,and the correlation between the optimal left atrioventricular interphase and heart rate was analyzed.The incidence of complications between two groups during follow-up were recorded.Results The optimized paced atrioventricular interphase and the corresponding left atrioventricular interphase in the optimized group were significantly longer than those before optimization[(162.5±21.3)ms vs.150.0 ms,(131.5±11.9)ms vs.(120.7±14.7)ms],and the differences were statistically significant(both P<0.05).There were no statistical differences in sensed atrio-ventricular interphase and corresponding left atrioventricular interphase[(125.0±22.6)ms vs.120.0 ms,(128.8±12.2)ms vs.(123.6±16.8)ms]before and after optimization.The effective diastolic time in the optimized group after optimization was significantly longer than that before optimization[(505.8±80.9)ms vs.(352.7±68.6)ms],the difference was statistically significant(P<0.05).The left ventricular global longitudinal strain and effective diastolic time in the optimized group were higher than those in the no

关 键 词：超声心动描记术 房室间期 双腔起搏器 心室功能 房室传导阻滞 

分 类 号：R540.45[医药卫生—心血管疾病] R318.11[医药卫生—内科学]