右心室流出道间隔部起搏的可行性和稳定性

Feasibility and Stability of Right Ventricular Outflow Tract Pacing Under Current Technology

目的:本研究通过右心室流出道间隔部(RVOT)起搏与右心室心尖部(RVA)起搏的比较,评价RVOT起搏在目前植入技术条件下的可行性和稳定性。方法:42例无器质性心脏病患者,平均年龄(63.5±10.4)岁,随机分到RVA组(n=14)和RVOT组(n=28),所有患者均植入主动固定电极导线和带有自动起搏阈值测试功能的起搏器。通过手术时间、术中X线曝光时间及术中电极导线的各项参数评价RVOT起搏的可行性;通过急、慢性期起搏阈值及并发症评价RVOT起搏的稳定性。结果:RVA组和RVOT组的手术时间、曝光时间、术中电极导线各项参数等指标差异均无统计学意义(P均>0.05);RVOT组急性期起搏阈值稳定性与RVA组相近(P=0.23);两组术后6个月时起搏阈值分别为(0.55±0.11)V和(0.54±0.09)V(P=0.787),差异无统计学意义;随访期中,两组并发症发生率亦相近。结论:在目前的起搏技术条件下,RVOT起搏的可行性和稳定性与传统的RVA起搏相近。

Objectives ：To assess the feasibility and stability of right ventricular outflow tract （ROVT） pacing under current technology by comparing the results of ROVT pacing with the traditional right ventricular apex （RVA） pacing. Methods ：A total of 42 patients （at mean age of 63.5 ± 10. 4 years） without structural heart disease were randomly divided into two groups. RVA pacing group （n = 14） ,and RVOT pacing group（n =28）. An active fixation lead was implanted in all patients whose pacemaker could automatically measure the pacing threshold every day. The operation time, X-ray exposure time and lead parameters detected during the operation were collected to evaluate the feasibility of RVOT pacing. The complications related to lead and implantation procedure and the trend of threshold change during the follow-up time were used to assess the stability of RVOT pacing. Results ： There were no statistic differences between RVA pacing group and RVOT pacing group in terms of operation time, X-ray exposure time and lead parameters. In RVOT group, the change of threshold during acute period was similar to those in RVA group （ P = 0. 23 ）. Chronic pacing threshold was also comparable between two groups, mean threshold at 6 months follow- up time was 0. 55 ±0.11V and 0. 54 ±0. 09V at 0. 4 pulse width in RVA group and RVOT group respectively （P =0. 787）. Conclusion： RVOT pacing was feasible and stable in operation time and lead characteristics compared with the conventional RVA pacing under current pacing technology.