心室激动顺序对生理性心脏起搏血液动力学影响的临床研究

Clinical assessment of the effect of ventricular activation pattern on hemodynamics with physiologic pacing

目的:评价心室激动顺序正常与否对生理性心脏起搏时心室血液动力学的影响。方法:15例(男性7例,女性8例)病态窦房结综合征(SSS)患者,平均年龄60.4±7.2岁(50～74岁),植入双腔起搏器(DDD)平均时间32.7±19.8个月(1～59月)。应用核素平衡法心室造影(ERNA)和 M 型超声心动图分别测定三种起搏条件:心房按需起搏(AAI),DDD 房室延迟时间(AVD)150ms,和 DDD 起搏 AVD 100ms 的左室收缩舒张功能参数和左右室心肌激动协调性指标。结果:AAI 起搏的左室射血分数(LVEF)与 DDD 起搏(AVD150ms,AVD100ms)相比,分别增加6.2%,5.2%(p<0.05),室间隔 EF 增加22.4%,15.3%(P<0.01),峰射血率(PER)增加7.5%,5.7%(P<0.05),峰充盈率(PER)增加14.3%,7.1%(P<0.05)。另外,DDD 起搏与 AAI 起搏比较,左、右室相角程及其半高宽均显著增大(P<0.001),右室开始收缩时间明显提前(P<0.001)。三种起搏条件下左室充盈时间(LVFT)差异不明显。结论:AAI 起搏维持正常心室舒缩顺序,与 DDD 起搏相比,显著改善左室功能并提高左右心室激动协调性。

Objective:To evaluate the effect of ventricular activation pattern on hemodynamics with physiologic pacing.Methods:Fifteen patients(7 males and 8 females),mean aged 60.4±7.2 years(50 ～74)with sick sinus syndrome(SSS)were studied,mean 32.7±19.8 months(1～59 months)after im- planting DDD pacemakers.ERNA and M-mode ultrasonography were used to determine the left ventricular systolic and diastolic functions and ventricular contraction homogeneity during the different pacing modes (AAI,DDD with AVD 150 ms,DDD with AVD 100 ms).Results:Compared with DDD(with AVD 150ms,AVD 100ms),AAI pacing has got better hemodynamic effects.The LV ejection fraction(EF)were 5.2%,6.2% higher(P<0.05);the septal EF's were 15.5%,22.4% higher(P<0.01);the peak ejection rates(PER)were 5.7%,7.5% higher(P<0.05);and the peak filling rates were 7.1%,14.3% higher (P<0.05),respectively,in AAI pacing.The ventricular phase angles were markedly decreased(P<0.01) in AAI pacing.Conclusion:AAI pacing preserved normal ventricular contraction patterns and signifi- cantly improved LV function and ventricular contraction homogeneity than DDD(AVD 150 ms,AVD 100 ms)pacing did..