双腔起搏不同房室延迟对左室舒张功能的影响

The effects of different atrioventricular delays on left ventricular diastolic function in patients with dual-chamber pacemakers

目的探讨植入双腔起搏器(DDD)术后患者不同房室延迟(AVD)、不同起搏状态对左室舒张功能的影响。方法选择30例接受DDD心脏起搏器治疗的病窦综合征患者,术后随访时,通过程控调节患者的AVD,采用彩色多普勒超声心动图测量不同起搏状态下患者的Tei指数、早期二尖瓣减速时间(DT)与舒张早期运动速度/舒张晚期运动速度(Em/Am)等左室舒张功能指标,用免疫荧光法测定血浆B型利钠肽(BNP),并比较不同起搏状态下以上各指标的差异。结果部分起搏与全部起搏状态下的心脏彩超舒张功能指标及BNP比较差异有显著性(<0.01),全部下传与部分起搏状态下的心脏彩超舒张功能指标及BNP比较差异有显著性(<0.01)。结论全部下传状态下患者的左室舒张功能最佳,提示AVD的选择对植入DDD的病窦综合症病人有重要意义。

Objective To investigate the effects of different AV delay and pacing model on the diastolic function of patients with dual cardiac chamber pacing. Methods 30 cases diagnosed as sick sinus syndrome （SSS） and undergone cardiac pacing （DDD model） implantation were recruited. AV delay was modulated to different length during follow-up, then the parameters in Echocardiography such as Tel index, early mitral diastolic attenuation time （DT） and Em/Am, as well as the BNP level measured by ILISA method, were employed to evaluate the cardiac diastolic function. Results The Echo index reflecting cardiac diastolic function and plasma BNP level between patients with partial and total pacing were significantly different （P〈0.01）, which were also significantly different between patients with no pacing and partial pacing （P〈0.01）. Conclusion The diastolic function of left ventricular in patients with no pacing and normal AV rhythm still keeps best compared with patients with different AV delay, reflecting the value of optimized AV delay in patients with SSS and implanted with DDD pacemaker.