伴有完全性右束支传导阻滞选择心室永久起搏部位的临床研究

Selection of permanent pacing position of cardiac ventricle in patients with complete right bundle branch block

目的针对伴有完全性右束支传导阻滞的缓慢性心律失常,比较在心室不同部位起搏,观察最佳起搏部位的疗效。方法8例病态窦房结综合征(SSS)或(和)Ⅲ度房室传导阻滞(Ⅲ°AVB)患者,伴有完全性右束支传导阻滞(RBBB),心功能未见异常或心功能Ⅰ级,均安置DDD型双腔永久起搏器。每例患者都分别在右室4个部位起搏,观察起搏QRS时限,以起搏时限最小部位作为永久心室起搏部位,并随访观察心功能、胸部X线片、左室射血分数(LVEF)。结果8例患者均以右室近后间隔作为永久心室起搏部位,此部位的起搏QRS时限均小于术前自身QRS时限(P<0.05),也均小于右室其他部位起搏时QRS时限,永久起搏部位测试参数均符合正常标准。术后随访6～36个月,8例患者的心功能均无异常变化。结论提示缓慢性心律失常患者伴有RBBB,需安置永久心室起搏治疗时,流入道与流出道结合部(近后间隔),是生理化程度较为理想的起搏部位。

Objective To find out the optimal pacing localization by comparing different pacing positions of the fight ventricle in brady-cardiacarrhythmia patients with complete fight bundle branch block. Methods DDD type of double lumen permanent pacemaker was implanted in each of the 8 cases of sick sinus syndrome（SSS） and/or Ⅲ° atrioventficular block （Ⅲ°AVB） with complete fight bundle branch block in normal heart function or class Ⅰ . For each patient, four pacing positions in fight ventricle were compared and the QRS pacing durations were recorded. The position with the shortest the QRS duration was chosen as the permanent pacing position. Heart function, chest X-rays and left ventricle ejection fraction （LVEF） were followed up after the operation. Results In all the 8 cases, the posterior septum of the fight ventricle were chosen as the permanent pacing position, with the shorter pacing QRS duration than that of pre-operation （ P 〈 0.05） and other pacing positions of the fight ventricle. All parameters of this permanent pacing position were within the normal range. During the follow-up of 6 - 36 months, no abnormity was found in cardiac functions. Conclusion In brady-cardiacarrhythmia patients with complete fight bundle branch block, the implantation of permanent pacemaker should be at the junction region of inlet and outlet tracts, of the posterior septum of the fight ventricle with ideal physiological function.