右心室间隔部起搏的核素心室显像位相分析及心电图研究  

Radionuclide Phase Image Analysis and Electrocardiogram Research in Patients With Right Ventricular Septal Pacing

作　　者：郭诗东[1] 华伟[1] 张澍[1] 王方正[1] 支力大[1] 史蓉芳[2] 何作祥[2] 陈新[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院电生理研究室 [2]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院核医学科,北京市100037

出　　处：《中国循环杂志》2003年第4期297-299,共3页Chinese Circulation Journal

摘　　要：目的 :观察右心室间隔部 (RVS)起搏时的心室激动顺序和双心室同步性 ;评估在接受心室起搏的患者中心电图的演变。　　方法 :慢性心房颤动伴长RR间歇或缓慢心室率需植入永久起搏器患者 10例 ,男性 7例 ,女性 3例 ,平均年龄(64 2 0± 12 61)岁 ,均采用抑制型按需心室起搏 (VVI)模式先后顺序进行右心室心尖部 (RVA)和RVS。记录术前心电图、术中RVA和RVS起搏心电图 ;术后进行核素心室显像位相分析 ,对比自身心律与RVA和RVS起搏时心室激动顺序和双心室同步性的差异。　　结果 :核素心室显像位相分析证实RVA起搏造成心室激动顺序异常和双心室失同步 ;RVS起搏时心室激动顺序、双心室同步性与正常基本一致。RVA起搏时QRS波群较术前自身增宽 [(173 0 0± 14 94)msvs (74 5 0± 7 62 )ms ,P <0 0 0 1] ,差异有非常显著性 ;RVS起搏的QRS波群宽度较RVA起搏缩窄 [(13 6 0 0± 13 5 0 )msvs (173 0 0± 14 94)ms ,P <0 0 0 1) ] ,差异有非常显著性。　　结论 :RVS起搏时心室激动顺序、双心室同步性与正常基本一致 ;与RVA起搏相比RVS起搏时心电轴、QRS波群与正常心电图相似或接近。Objective:To observe ventricular activation sequence and biventricular contraction synchrony in patients with ventricular septal pacing,and to evaluate the evolution of electrdardiogram(ECG)in patients undergoing ventricular pacing. Methods:Ten patients with chronic atrial fibrillation and long RR interval or slow ventricular beats underwent permanent pacing(7 males and 3 females,mean age 64.2 years).VVI pacing was performed in all patients.We recorded surface ECG before implantation,and ECG for right ventricular apex (RVA) and right ventricular septum (RVS) pacing.Equilibrium radionuclide angiography(ERNA) phase image analysis was performed after operation.Ventricular activation sequence and biventricular contraction synchrony during RVS and RVA pacing were compared with those of the intrinsic rhythm. Results:① ERNA phase image analysis showed that RVA pacing resulted in abnormal ventricular activation sequence and asynchronous biventricular contraction.Ventricular activation sequence and biventricular contraction synchrony during RVS pacing were roughly normal.② The QRS complex duration of surface ECG was significantly increased during RVA pacing compared with the intrinsic level [(173.00±14.94)ms vs (74.50±7.62)ms,p<0.001].In contrast to RVA pacing,the QRS duration of RVS pacing was narrowed by (37.00±12.52)ms[(136.00±13.50)ms vs.(173.00±14.94)ms,p<0.001]. Conclusion:Ventricular activation sequence and contraction synchrony during RVS pacing were consistent with those of the normal subjects.In contrast to RVA pacing,the axis and QRS complex on ECG during RVS pacing were similar to those of the intrinsic rhythm.

关 键 词：右心室间隔部起搏 核素心室显像 位相分析 心电图 慢性心房颤动 

分 类 号：R541.75[医药卫生—心血管疾病] R540.41[医药卫生—内科学]