长期右心室心尖起搏对左心形态与收缩功能影响的研究  

Long term right ventricular apical pacing does not affect left ventricular morphology and systolic function

作　　者：信满坤 杨庚 田轶伦[2] 文勃[1] XIN Mankun;YANG Geng;TIAN Yilun;WEN Bo(Department of Emergence and Critical Care Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所,急诊危重症中心,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所,心脏起搏与CIED中心,100029

出　　处：《心肺血管病杂志》2023年第7期672-678,共7页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:长期慢性右心室心尖部起搏(right ventricular apical pacing,RVAp)对于基线LVEF≥50%、无严重结构性心脏病患者的电极参数变化及左心室同步性、形态和收缩功能改变。方法:连续纳入2019年5月1日至2021年6月30日在安贞医院接受永久双腔起搏器置换术的183例成年患者(RVAp组)及匹配的健康成年人(对照组)。比较RVAp组在置入时或置换术中的电极参数,以及置入前或置换前比较RVAp组与对照组在临床基线数据、平均QRS间期/起搏QRS间期(QRSd/pQRSd)、二尖瓣反流程度(mitral regurgitation,MR)、三尖瓣反流程度(tricuspid regurgitation,TR)和肺动脉收缩压程度(pulmonary artery systolic pressure,sPAP)、LAD、LVEDD和LVEF方面。结果:更换时右心室电极起搏阈值显著升高(P<0.001)、电极阻抗明显下降(P<0.001),R波感知呈下降趋势,其中AVB亚组R波感知下降更显著。与固有房室传导完整组(即对照组或SSS亚组)相比,起搏百分比更高的AVB组的LVEDD较对照组明显增大(P=0.046)。基线时RVAp组的TR程度比对照组明显恶化(P=0.002),而随访时,无论是TR、MR还是PAP程度均较对照组明显恶化(均P<0.05)。RVAp组的pQRSd显著长于对照组的QRSd(P<0.001),且SSS亚组和AVB亚组也显著长于对照组的QRSd(均P<0.001)。与对照组相比,RVAp组LVEF并无明显下降,但AVB组患者的LVEF较对照组或SSS组有显著下降(均P<0.05)。结论:长期慢性RVAp的电极参数稳定。与对照组相比,对于基线LVEF≥50%、无严重结构性心脏病人群,长期慢性RVAp组虽然存在显著不同步性,且MR、TR和PAP程度明显恶化,但左心房和左心室无形态学显著增大,更重要的是LVEF无明显下降。尤其是SSS亚组表现更佳。Objective:To clarify the changes in electrode parameters,left ventricular synchronicity,morphology,and systolic function in patients with baseline LVEF≥50%and no severe structural heart disease during long-term chronic right ventricular apical pacing(RVAp)in the real world.Methods:A total of 183 adult patients(RVAp group)who underwent permanent dual chamber pacemaker replacement operation in our hospital from May 1,2019 to June 30,2021,and matched healthy adults(control group)were included in the study.Compare the electrode parameters of the RVAp group at implantation with that of replacement,as well as compare the clinical baseline data,average QRSd/pQRSd,MR,TR,and sPAP degree,LAD,LVEDD,and LVEF between the RVAp group and the control group before implantation or replacement.Results:During replacement,the pacing threshold of the right ventricular electrode significantly increased(P<0.001),the electrode impedance significantly decreased(P<0.001),and the R-wave amplitude showed a downward trend,with the AVB subgroup showing a more significant decrease in R-wave amplitude.Compared with the group with intact atrioventricular conduction(i.e.control group or SSS subgroup),the LVEDD of the AVB group with higher pacing percentage was significantly increased compared to the control group(P=0.046).At baseline,the TR severity of the RVAp group was significantly worse than that of the control group(P=0.002),while at follow-up,both TR,MR,and PAP severity were significantly worse than those of the control group(all P<0.05).The pQRSd of the RVAp group was significantly longer than that of the healthy adult group(P<0.001),and the SSS subgroup and AVB subgroup were also significantly longer than that of the healthy adult group(both P<0.001).Compared with the control group,there was no significant decrease in LVEF in the RVAp group,but there was a significant decrease in LVEF in the AVB group compared to the control group or SSS group(all P<0.05).Conclusions:The electrode parameters of long-term chronic RVAp were stable.Compared

关 键 词：长期右心室心尖部起搏 电极参数 左心形态学 同步性 左心室收缩功能 

分 类 号：R54[医药卫生—心血管疾病]