右心室流入道间隔部起搏血流动力学研究

Hemodynamic study of pacing at the right ventricular inlet septum

目的本文旨在对右心室流入道间隔部起搏的血流动力学进行分析,以确立右心室流入道间隔部起搏的临床地位。方法本研究通过射频消融房室结建立Ⅲ°房室传导阻滞模型,结合影像学及心电图定位方法于右心室流入道间隔部置入螺旋电极导线,并分别比较右心室心尖部、右心室流出道及右心室流入道间隔部起搏后急性血流动力学指标变化,并随访右心室流入道间隔部起搏2周后的血流动力学指标。结果即刻血流动力学研究结果显示,右心室流入道间隔部较心尖部和右心室流出道起搏心排血量高(P<0.05),左心室舒张末期压力较低(P<0.05),而右心室流入道间隔部起搏前后各项血流动力学无显著变化。结论右心室流入道间隔部起搏具有良好的血流动力学效应,可作为右心室心尖部起搏的替代起搏部位。

Objective To confirm the clinical value of pacing at the right ventricular inlet septum. Methods AⅢ degree AV block model was created in animal through RFCA and a spiral electrode was implanted at the right ventficular septum via integration of imaging techniques and electrocardiogram positioning. Changes in hemodynamic indexes at the right ventricular apex, right ventricular outflow tract and right ventricular inlet septurn before and after pacing were compared. Two weeks later after fight ventficular inlet septum pacing, hemodymamic indexes were again monitored. Results Instant hemodynamic study reveals that compared with right ventficular apex and outflow tract, pacing at the fight ventficular in let septum leads to higher blood discharge from the heart（ P 〈 0.05） and lower pressure towards the end of the left ventricular diastolic cycle. There are no any change of hemodynamic before and after pacing at right ventricular inlet sept um. Conclusion Pacing at the right ventricular inlet septum has better hemodynamic effects. It would be a substitute of pacing at right ventficular apex.