右室起搏对左室舒张和充盈动力学的影响

EFFECTS OF RIGHT VENTRICULAR PACING ON LEFT VENTRICULAR FILLING DYNAMICS

①目的观察和分析右心室起搏对左心室舒张和充盈动力学的影响。②方法利用脉冲多普勒分别测量５３例安装人工心脏起搏器的病人在自发心律和８０次／ｍｉｎ的起搏心律时的左室舒张和充盈参数。其中２７例术前存在完全性左束支传导阻滞（Ａ组），２６例术前无左束支传导阻滞（Ｂ组）。③结果Ａ组病人的左室舒张和充盈参数在心律变换前后无显著性变化（ｔ均＜２．０，Ｐ均＞０．０５），而Ｂ组病人起搏心律时的快速充盈减速时间和左室等容舒张时间显著性延长（ｔ＝２．９８，Ｐ＜０．０１；ｔ＝３．９６，Ｐ＜０．００１）。当两组病人依同一频率起搏时，左室舒张和充盈参数在两组之间无显著性差异（ｔ均＜２．０，Ｐ均＞０．０５）。④结论右心室起搏导致了一种与左束支传导阻滞相似的左室舒张和充盈形式。

Objective The aim of the paper was to analyze the possible effects of right ventricular pacing on left ventricular filling dynamics. Method The study population consisted of 53 patients with implanted pacemakers, 27 with left bundle branch block (Group A), and 26 without left bundle branch block (Group B). Left ventricular isovolumic relaxation time, early and late peak velocity, E/A ratio and deceleration time were measured by pulsed Doppler in all patients. The Doppler trace was recorded at spontaneous rhythm after inhibiting the pacemaker, and then at the programmmed rate of 80 beats/min. Result In group A, there were no changes in the Doppler parameters when passing from a spontaneous to apaced rhythm ( t<2.0, P >0.05). In group B, deceleration time and isovolumic relaxation time were increased significantly at paced rhythm ( t=2.98,P <0.01, and t=3.96, P< 0.001, respectively). No differences were found when comparing the Doppler parameters of the two populations at the same pacing rate ( t<2.0, P> 0.05). Conclusion Right ventricular pacing induced a left ventricular filling pattern, which was similar to that of left bundle branch block.