房间隔起搏在心脏再同步治疗中的应用

The application of atrial septal pacing in cardiac resynchronization therapy

目的通过简单的超声多普勒方法评价房间隔起搏在心脏再同步治疗（CRT）中的效果。方法在23例行CRT治疗的患者中进行了超声多普勒测量，9例患者存在房间阻滞，心房起搏导线固定在房间隔，其余14例常规固定在右心耳。结果右心耳起搏组中心房间传导延迟时间（IAD）延长[（46±20）ms vs（53±23）ms，P〈0．05]，IAD和心室间传导延迟时间（IVD）的差异增大[（53±23）ms VS（40±17）ms，P〈0．05]，左机械房室延迟时间（LMAVD）和右机械房室延迟时间（RMAVD）的差异明显增加[（172±25）ms vs（210±32）ms，P〈0．001]。房间隔起搏后IAD明显减小[（34±12）ms VS（12±11）ms，P〈0．001]，IAD和IVD的差别减少[（12±11）ms VS（18±16）ms，P〉0．05]，LMAVD和RMAVD差异无统计学意义[（187±43）ms vs（182±50）ms，P〉0．05]。二尖瓣A峰速度时间积分在房间隔起搏后明显增加[（8．9±4．9）cm vs（13．0±4．0）cm，P〈0．001]。结论房间阻滞可以导致左心和右心房室收缩顺序的差异，房间隔起搏能纠正这种差异，增加二尖瓣舒张期充盈进一步改善心脏再同步治疗。

Objective We evaluated the atrial septal pacing effect in patients with cardiac resynchro-niztion therapy（CRT） by simple echo-Doppler. Methods Nine patients who had interatrial conduction delay had the atrial lead on the interatrlal septum. The others had the atrial lead in the right atrial appendage. We measured the parameters post-implantation. Results In group right atrial appendage,interatrial delay（IAD）was longer[（46±20）ms vs（53±23）ms,P 〈0. 05]after right appendage pacing. IAD was longer than interventricular delay （IVD）[（53±23）ms vs（40± 17）ms,P 〈0.05]. Left mechanical atrioventricular delay（LMAVD）was significantly shorter than right mechanical atrioventricular delay（RMAVD） [ （ 172±25）ms vs（210±32）ms ,P 〈 0. 001]. In group atrial septal pacing IAD was shrorter[ （34±12 ） ms vs （ 12±11 ） ms, P 〈 0. 001] after right artrial septal pacing. No differences were observed between lAD and IVD[ （ 12±11 ）ms vs（ 18±16）ms,P 〉0. 05] ,and no differences between LMAVD and RMAVD[ （187±43）ms vs（182±50）ms,P 〉0. 05]. Furthermore,velocity time integral（VTI）of mitral A spike was significantly increased after atrial septal pacing[（ 8. 9±4. 9） cm vs （ 13. 0±4. 0） cm,P 〈 0. 001] Conclusion Interatrial conduction delay can result in different left and right atrioventricular sequence in CRT. Atrial septal can recover such phenomena and improve the effect of CRT through longer the mitral diastolic filling.