希氏束起搏与右心室心尖部起搏对房室传导阻滞患者心脏结构学参数与功能学参数影响的临床研究

Effects of His bundle pacing and RVA pacing on cardiac structural parameters and functional parameters in patients with atrioventricular block

目的:探究希氏束起搏(HBP)与右心室心尖部起搏(RVAP)对房室传导阻滞(AVB)患者心脏结构学参数与功能学参数的影响。方法:选取收治的104例AVB患者为研究对象,随机分为HBP组和RVAP组各52例,HBP组行HBP治疗,RVAP组行RVAP治疗,比较两组术前、术后心脏结构学参数、心脏起搏参数、心率和血流动力学参数[心率(HR)、每搏输出量(SV)、心脏指数(CI)和左室射血分数(LVEF)]及QRS时限变化情况。结果:两组手术前后心脏结构学参数左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、室间隔厚度(IVS)、左室后壁厚度(LVPW)比较,差异均无统计学意义(均P>0.05);术中、术后1个月、术后6个月心脏起搏阈值、R波幅度、电极阻抗比较无统计学差异(均P>0.05);术前、术后1个月,两组HR、SV、CI、LVEF、QRS时限比较无统计学差异(均P>0.05);术后6个月,HBP组HR、SV、CI、LVEF显著高于RVAP组(均P<0.05),RVAP组QRS波时限显著低于HBP组(P<0.05);结论:HBP对AVB患者的电-机械同步性优于RVAP,近期心脏血流动力学及心功能稳定性良好。

Objective:To explore the effects of His bundle pacing(HBP)and right ventricular apex pacing(RVAP)on cardiac structural parameters and functional parameters in patients with atrioventricular block(AVB).Methods:A total of 104 patients with AVB were selected as the study subjects,and they were randomly divided into HBP group and RVAP group,with 52 cases in each group.The HBP group received HBP treatment,and the RVAP group received RVAP treatment.Cardiac structural parameters(left atrial end-systolic diameter[LVESD],left ventricular end-diastolic diameter[LVEDD],interventricular septal thickness[IVS],left ventricular posterior wall thickness[LVPW]),cardiac pacing parameters,heart rate and hemodynamic parameters(heart rate[HR],stroke volume[SV],Cardiac Index[CI],left ventricular ejection fraction[LVEF])and QRS wave duration were compared between the two groups before and after surgery.Results:There were no statistically significant differences in cardiac structural parameters such as LVESD,LVESDD,IVS and LVPW between the two groups before and after surgery(all P>0.05).There were no statistical differences in cardiac pacing threshold,R-wave amplitude and electrode impedance during surgery,at 1 month after surgery and at 6 months after surgery(all P>0.05).There were no statistically significant differences in HR,SV,CI,LVEF and QRS duration between the two groups before and 1 month after operation(all P>0.05).At 6 months after operation,HR,SV,CI and LVEF in the HBP group were significantly higher than those in the RVAP group(all P<0.05),and QRS duration in the RVAP group was significantly lower than that in the HBP group(P<0.05).Conclusion:The electromechanical synchronization of HBP in patients with AVB is better than that of RVAP,and its short-term cardiac hemodynamics and cardiac function stability are good.