体表心电图在双腔起搏器房室传导间期最佳化中的价值

Value of surface electrocardiography on atrioventricular delay optimization

目的:探讨置入了双腔起搏器的患者,在随访时,根据体表心电图P波宽度调节房室传导间期(AV间期)对血流动力学的影响。方法:因高度或Ⅲ度房室传导阻滞而安装美墩力SD303双腔起搏器的患者31例。测量患者体表心电图自身P波宽度,和(或)心房起搏脉冲至起搏的P波末端的宽度,在此测量值上加100ms,分别设定双腔起搏器的感知AV间期和起搏AV间期。使用多普勒超声仪,分别在出厂常规设置的AV间期和根据体表心电图优化的AV间期设定值,进行超声检查。结果:经体表心电图调整AV间期后的左室每搏量、左室舒张末期容量和左室射血分数、左室充盈时间、二尖瓣血流速度时间积分,均高于常规出厂设置的AV间期,前三者差异显著(P<0.05)。结论:根据体表心电图中P波宽度的变化来调节AV间期,不但能获得良好的血流动力学效果,且由于其简单易行,而具有广泛的临床实用价值。

Objective：To investigate the influence of surface electrocardiography（ECG） on atrio-ventricular delay（AVD） optimization. Method：DDD pacemakers were implanted in 31 patients with high degree or complete atrioventricular block. Optimal AVD was achieved by programming a delay of 100ms from the end of P- wave to the nadir of the paced ventricular complex. The stroke volumes（SV）, left ventricular end-diastolic volume （LVEDV） and left ventricular ejection fraction （LVEF） was measured by Doppler Echocardiography（DE） at nominal and optimal AVD. Result：Optimization of the AVD by ECG resulted in a significant increase in SV, LVEDV and LVEF determined by DE. Conclusion：Compare to nominal AVD setting, optimization of AVD by ECG is a simple method to improve left ventricular systolic function of patients with DDD pacemakers.