心电图P波宽度在优化双腔起搏器房室间期中的价值

The application of P-wave width in optimizing atrioventricular delay for dual-chamber pacemaker

目的:探索以心电图P波宽度优化双腔起搏器房室间期(AV间期)的方法,以期获得良好的血流动力学效果。方法:选择63例因Ⅲ度或高度房室传导阻滞植入Medtronic双腔起搏器的患者,测量其心电图自身P波宽度,或从心房起搏脉冲至起搏P波末端的宽度,在此测量值上加100ms,设定为双腔起搏器的感知AV间期(SAV)和起搏AV间期(PAV)。每例患者分别在出厂常规设置的AV间期和根据心电图优化的AV间期设定值下进行超声心动图检查,比较即刻血流动力学参数。结果:经心电图优化AV间期后,患者左室舒张末容积(LVEDV)、左室收缩末期容积(LVESV)和左室射血分数(LVEF)均较常规出厂设置的AV间期有显著改善(69.5±11.2比72.3±12.7;29.5±9.5比27.88±10.07;63.6±5.3比67.2±6.2,P<0.05)。结论:根据心电图P波宽度优化双腔起搏器AV间期,可获得良好的血流动力学效果,左室充盈改善,LVEF上升;且该法简单易行,具广泛的临床实用价值。

Objective To investigate the application of P wave width in electrocardiography （ECG） in optimizing atrioventricular delay （AVD） for dual-chamber pacemaker. Methods DDD pacemakers were implanted in 63 patients with high degree or complete atrioventricular block. Optimal AV delay was achieved by programming an extra delay of lOOms to the width of intrinsic P wave or pacing spike to the end of P wave on the surface electrocardiogram. Left ventricular end diastolic volume （LVEDV）, left ventricular end systolic volume （LVESV） and left ventricular ejection fraction （LVEF） were measured by Doppler echocardiography （DE） at nominal and optimal AVD. Results Optimization of the AVD by ECG resulted in a significant improvement in LVEDV, LVESV and LVEF determined by DE. Conclusions Optimization of AVD by ECG is a simple method to improve left ventricular systolic function of patients with DDD pacemakers.