右室间隔部主动电极和右室心尖部被动电极的对照研究

Comparative study between right ventricular septal pacing and right ventricular apical pacing

目的 探讨采用主动固定螺旋电极行右室高位间隔部起搏的可行性和安全性。方法 采用随机对照临床研究，将需要放置心脏起搏器的64例患者，随机分成两组，34例采用主动固定电极行右室高位间隔部起搏（右室间隔部主动固定组），30例采用被动固定电极行右室心尖部起搏（右室心尖部被动固定组）。对比两组患者在植入术中及术后起搏参数的变化。结果 （1）两组植入手术时间平均分别为（59.6±3．2）、（60．2±3．7）min，差异无统计学意义，但右室间隔部主动同定组x线曝光时间延长（P〈0．01）。（2）右室间隔部主动固定组植入术中及术后1个月的起搏阈值高于右室心尖部被动固定组（P〈0．05或〈0．01），但术后3个月时比较差异无统计学意义。（3）植入术后1个月及3个月，右室间隔部主动固定组阻抗明显低于右室心尖部被动固定组（P〈0．01或〈0．05）。（4）心室100％起搏时QRS时限右室间隔部主动固定组较右室心尖部被动固定组窄，但差异无统计学意义。（5）两组均顺利完成手术，未出现严重并发症。结论使用主动固定螺旋电极行右室间隔部起搏是安全可行的。

Objective To explore the feasibility and safety of right ventricular septal pacing with active fixation electrodes. Methods This was a randomized and control clinical trial. Patients implanted with pacemaker were randomly divided into two groups. One group underwent the right ventricular high septal pacing with the active fixation electrodes （RVS group）, and the other group underwent the right ventricular apical pacing with the passive fixation electrodes （control group）. The parameter was recorded in two groups in and after operation and compared accordingly. Results （ 1 ） There were no significant differences in the procedure time between two groups [averaged （59.6 ± 3.2） and （60.2 ± 3.7 ）minutes respectively ]. But the time of exposing X-ray was significant longer in RVS group. （2） There was no significant difference in acute implanting measurement, except perioperative and postoperative threshold 1 month in RVS group was higher than that in control group （P 〈0.05 or 〈0.01）. After 3 months, there was no significant difference. （3） Impedance decreased significantly in 1 month and 3 months in RVS group （P 〈 0.01 or 〈 0.05 ）. （4） There was no difference in R-wave sensing between two groups. （5） After 100% pacing, the mean QRS duration was shorter in RVS group, but the difference was not significant . （6） Operations in two groups came off smoothly and there were no complications. Conclusion It is feasible and secure to pace from RVS with active fixation electrodes.