右心DDD起搏的同位素位相分析  

Phase analysis of right ventricular DDD pacing

作　　者：支力大[1] 华伟[2] 史蓉芳[2] 张澍[2] 王方正[2] 刘秀杰[2] 

机构地区：[1]中日友好医院急诊科,北京100029 [2]中国医学科学院阜外心血管病医院临床电生理科,北京100037

出　　处：《中日友好医院学报》2003年第5期265-268,共4页Journal of China-Japan Friendship Hospital

摘　　要：目的 :用平衡法核素心室显像 (ERNA)位相分析方法评价右心DDD起搏的心室激动顺序和心室同步性。方法 :对 10例正常者及 10例植入DDD起搏器的病态窦房结综合征或间歇Ⅱ°房室阻滞患者行ERNA。在起搏心律和窦性心律下采集数据 ,分析处理位相 ,比较两者的相角程、心室激动顺序、最早激动点与X线定位的心室电极位置。结果 :正常者位相图示双心室色阶均一 ,心室直方图窄 ,相角程为 5 1.75°± 5 .81° ,心室激动顺序从室间隔近端或左室基底部向心尖方向扩散。行DDD起搏者起搏时右室激动早于左室 ,相角程显著增宽(6 4 .13°± 16 .81°vs 5 2 .88°± 9.2 6° ,P <0 .0 1) ,心室激动顺序发生改变 ,从右室心尖部向心底部和左室扩散 ,最早激动点为右室心尖部和室间隔远端 ,与X线显示右室电极位置一致。 2组观测者自身心律时的相角程无显著差别 (P >0 .0 5 ) ,起搏时的相角程差异显著 (P <0 .0 5 )。结论 :单纯右心室起搏改变心室激动顺序 ,增加心室不同步性 ;位相分析可以准确定位心室起搏电极位置。Objective:To evaluate the effect of right atrial and ventricular DDD pacing on ventricular activation and ventricular contraction synchrony by equilibrium radionuclide angiography(ERNA). Methods: Group 1 included 10 individuals with a normal ECG, normal wall motion and cardiac function. Normal phase image was obtained from this group. Group 2 included 10 patients with SSS or intermittent Ⅱ° AVB implanted with right atrial and ventricular DDD pacing. Group 1 underwent ERNA only once. The test was performed on group 2 3-6 days after implantation. The scintigraphic data were obtained during spontaneous sinus rhythm and during pacing rhythm. Phase image analysis was used to study ventricular activation sequence and ventricular synchrony. The site of phase onset was compared with the position of ventricular electrode on X-ray film. Results: (1) Group 1 Phase image analysis revealed a homogeneous pattern and a narrow histogram. The phase shift was 51.78°±5.81°. The activation of two ventricles occurred at the same time, from proximal septum or left ventricular base to cardiac apex. (2) Group 2 phase analysis showed right ventricle activated earlier than left ventricle during pacing, and phase shift was significantly greater during pacing than during sinus rhythm (64.13°±16.81° vs 52.88°±9.26°, P<0.01). The activation of two ventricles occurred at the same time during sinus rhythm, and spread from proximal septum or left ventricular base to cardiac apex. The earliest activation occurred at right ventricular apex and spread to cardiac base part and left ventricle during pacing. The phase onset corresponded to the position of right ventricular electrode identified on X-ray film. (3) Phase shift was similar between group1 and group2 during sinus rhythm. Group 2 had a significantly greater phase shift during pacing rhythm compared with group1. Conclusion: Right ventricular pacing changed ventricular activation and reduced ventricular synchrony. Phase analysis could localize the pacing site.

关 键 词：平衡法核素心室显像 位相分析 DDD起搏 ERNA 同位素 心率 

分 类 号：R541.7[医药卫生—心血管疾病]