房间隔起搏对病窦综合征（快慢型）患者房颤及心功能的影响

Effects of atrial septum pacing on atrial fibrillation and heart function in patients with sick sinus syndrome

目的本研究拟选取房间隔作为新的心房起搏位置，与传统的基于右心耳的双腔起搏比较，观察该方式对病窦综合征（快慢型）患者房颤发作及心功能的影响。方法选取病窦综合征（快慢型）患者，实验组29例，对照组31例。术前心脏彩色超声测定左房内径，左室舒张末期内径，左室射血分数，测定血清N末端脑钠肽前体水平，均行双腔起搏器治疗。实验组先行心内电生理检查，选择双心房同步激动的房间隔最佳起搏点，心房电极置于该位置。对照组心房电极置于传统的右心耳。比较术后3月、6月、9月、12月时两组房颤负荷，左房内径，左室舒张末期内径，左室射血分数，血清N末端脑钠肽前体水平。结果置入起搏器术后1年，实验组无房颤发生和房颤负荷减少20例（71．4％），与对照组比较差异有统计学意义（71．4％ VS 48．4％），术后1年房颤平均每天发作时间，左房内径，左室舒张末期内径，左室射血分数，N末端脑钠肽前体均有显著性差异：（78．8±6．9）min VS （106．7±12．8）min，（36．2±4．8）mmVS（41．7-4-6．1）mm，（49．8±6．1）mm VS （66．5±4．2）mm，（63．3％±4．1％） VS （49．1％±6．9％），（330．8±30．5）pg／ml VS （502．8±21．4）pg／ml。结论基于房间隔起搏的房室顺序起搏方式较传统的房室顺序起搏减少病窦综合征（快慢型）患者房颤的发作，改善左室重构，延缓心功能恶化。

Objective To investigate the effect of atrial septum pacing on atrial fibrillation and heart function on patients with sick sinus syndrome compared with traditional dual-chamber pacemaker, Methods A total of 60 patients were enrolled into study group and control group. All patients received dual-chamber pacemaker. The active fixation pacing atrial lead was implanted in atrial septum in study group, the patients in control group received traditional dual-chamber pacemaker. The indexes about left ventricular remodeling and cardiac function were measured by Doppler echoeardiography and N-terminal pro brain natriuretic peptide level by Chemiluminescence Determination respectively on the 3rd, 6th, 9th, 12th months. Results In one year follow-up after atrial septal pacemaker implanted, paroxysmal atrial fibrillation （PAF） disappeared or decreased in 20 patients （71.4%） in study group compared with that in control group （P 〈 0.05）. PAF duration, LAD, LVDd and N-terminal pro brain natriuretic peptide significantly reduced in the one year follow-up （78.8±6.9）min VS（ 106.7± 12.8）rain, （36.2±4.8）mm VS（41.7±6. 1）mm, and（49.8±6.1）mm VS（66.5±4.2）mm,（330.8±30.5）pg/ml VS（502.8±21.4）pg/ml. Conclusion Atrial septal pacing have a p preventive and therapeutic effect on PAF, left ventricular remodeling and heart function in patients with sick sinus syndrome.