心室激动收缩顺序对心功能和室壁运动的影响

The effect of contraction sequence on left ventricular function and wall motion

对１８只犬用房室交界区起搏和快速电影摄影法，进一步研究室内传导正常对心功能和室壁运动的影响。结果表明，右房—房室交界区顺序（ＡＮＳＰ）起搏比右房—右室顺序起搏（ＡＶＳＰ）时的血液动力学指标有所增加，如心排出量增加２５％，室壁节段运动幅度（如前游离壁）增加４８％。结论是，维持房室顺序和室内传导正常的ＡＮＳＰ比仅维持房室顺序的ＡＶＳＰ效应更好，提示室内传导正常对心功能有重要影响。

Abstract Recent studies have suggested that left ventricular (LV) contraction sequence (CS) has a greater effect on hemodynamics than was previously recognized.Therefore, hemodynamic effects of LVCS were further evaluated.Methods: LVCS and atrioventricular CS were varied by pacing. Pacing modes (PM) used were right atrial (RAP) or right ventricular (RVP) in 8 dogs and RA-AV node sequential (ANSP) and RA-RV sequential (AVSP) in 10 dogs. From LV right anterior oblique angiograms we measured radial grid lengths of walls : apical (AP), anterior (AW), inferior (LW),and basilar (BW). Stroke volume (SV) ejectionfraction (EF), cardiac output (CO), and cardiac index (CI) were calculated. Statistics : PM commparisons in same dog were by Wilcoxon test and in different dogs by Mann-Whiteney test.Results: parameters of hemodynamics such as Co increased 25%, and LV segment motion such as AW increased 48% when ANSP vs AVSP comparisons.Conclusions: AVSP and RVP resulted in significantly decreased LV function compared to the other pacing modes ANSP. Thus, LVCS is an important determinant of hemodynamic performance and is as cirtical as AV synchrony.