右心室流出道与低位间隔起搏患者心电学参数变化及预后对比研究

A comparative study of electrocardiographic parameters and prognosis in patients with right ventricular outflow tract versus low atrial septal pacing

目的 比较右心室流出道与低位间隔起搏对心脏起搏器植入治疗患者心电学参数变化及预后的影响。方法 回顾性选取2019年1月至2021年10月在池州市人民医院采用心脏起搏器植入治疗患者145例,按照起搏器电极植入部位不同分为观察组(n=69,右心室流出道间隔部起搏)和对照组(n=76,右心室低位间隔起搏)。比较两组手术前后心电学参数(R波感知、起搏阈值、阻抗、QRS波时限、QTc间期)、心功能[N末端B型脑钠钛前体(NT-proBNP)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)]及预后情况。结果 术中、术后两组R波感知、起搏阈值、阻抗、QRS波时限、QTc间期比较,差异均无统计学意义(P>0.05)。术前,两组血浆NT-proBNP、LVEF、LVEDD比较,差异均无统计学意义(P>0.05),术后,观察组血浆NT-proBNP、 LVEDD水平分别为(336.42±35.46) ng/L、(48.51±5.82) mm,均低于对照组[(363.78±38.76) ng/L、(49.78±5.92) mm],LVEF为(55.42±7.34)%,高于对照组[(52.62±7.12)%],差异均有统计学意义(P<0.05)。随访1年,观察组出现阵发性房颤1例,不良预后发生率为1.45%(1/69)。对照组出现阵发性房颤2例,因心力衰竭再次入院1例,不良预后发生率为3.95%(3/76),两组患者不良预后发生率比较,差异无统计学意义(P>0.05)。结论 右心室流出道间隔部起搏与低位间隔起搏对心脏起搏器植入治疗患者心电学参数差异不大,但前者对患者心功能影响更小,预后更好。

Objective To compare the effects of right ventricular outflow tract septal pacing and low atrial septal pacing on electrocardiographic parameters and prognosis in patients undergoing pacemaker implantation.Methods One hundred and forty-five patients with pacemaker implantation in People's Hospital of Chizhou From January 2019 to October 2021 were retrospectively enrolled,and assigned into observation group(n=69,right ventricular outflow tract septal pacing)and control group(n=76,right ventricular low atrial septal pacing)according to different pacing sites.Then the electrocardiographic parameters(R wave sensing,pacing threshold,impedance,QRS duration,and QTc interval),cardiac function parameters[N-terminal pro-B type natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)]and prognosis were compared between two groups before and after operation.Results The intra-and post-operative R wave sensing,pacing threshold,impedance,QRS duration and QTc interval yielded no statistical difference between two groups(P>0.05).No statistical difference was found in plasma NT-proBNP levels as well as LVEF and LVEDD values between two groups at baseline(P>0.05).After operation,the levels of plasma NT proBNP and LVEDD in the observation group were(336.42±35.46)ng/L and(48.51±5.82)mm,respectively,which were lower than those in the control group[(363.78±38.76)ng/L and(49.78±5.92)mm],and LVEF was(55.42±7.34)%,which was higher than that in the control group[(52.62±7.12)%],the differences were statistically significant(P<0.05).During 1-year follow-up,there was 1 case of paroxysmal atrial fibrillation in observation group,with an overall adverse prognosis rate of 1.45%(1/69).In control group,there were 2 cases of paroxysmal atrial fibrillation and 1 case of readmission due to heart failure,with an overall adverse prognosis rate of 3.95%(3/76).The adverse prognosis rate showed no statistical difference between two groups(P>0.05).Conclusion The difference in electrocardiographic parameters between right ventricular outflow tract septal pacing and low atrial septal pacing in patients with pacemaker implantation is not significant,but the former has less impact on cardiac function and a better prognosis.