右心室流出道间隔部起搏与心尖部起搏的血流动力学对比研究

Comparison of hemodynamic changes in patients with right ventricular outflow tract septal pacing and right ventricular apical pacing

目的比较右心室流出道间隔部(RVOTS)与右心室心尖部(RVA)起搏对血流动力学的影响,评价RVOTS起搏的可行性。方法 53例需植入永久起搏器患者,均采用抑制型按需心室起搏模式(VVI),其中RVA起搏28例,RVOTS 25例。随访3～10个月,采用超声心动图检查方法检测血流动力学参数,包括LVEF、左室内径缩短分数(FS)、心输出量(CO)、心脏指数(CI),研究RVOTS与RVA起搏的术前、术后血流动力学差异。结果所有患者心室起搏保证在80%以上,与手术前比较,RVOTS起搏时,LVEF、FS、CO、CI分别下降了3.46%±3.89%、1.20%±2.47%、(0.19±1.32)L/min、(0.09±0.52)L·min^(-1)·m^(-2),差异无统计学意义(均为P>0.5)。与手术前比较,RVA起搏时LVEF、FS、CO、CI分别下降了14.27%±5.83%、8.10%±3.79%、(1.56±1.11)L/min、(1.13±0.52)L·min^(-1)·m^(-2)(均为P<0.01),RVOTS起搏与RVA起搏相比LVEF、Fs、CO、CI明显改善(均为P<0.05),且临床症状明显减轻。结论 RVOTS起搏对血流动力学无明显不良影响。

Objective To compare the hemodynamic changes in patients with right ventricular outflow tract septal （RVOTS） pacing and right ventrieular apical （RVA） pacing.. Methods Fifty-three patients underwent VVI pacemaker implatation were included and divided into RVOTS pacing group （ n = 25 ） and RVA pacing group （ n = 28）. Hemodynamic parameters, including left ventricular ejection fraction （LVEF）, shortening fraction of left ventricular innerdiamcter （SF）, eardie output （CO） and eardie index （CI）, were detected by ultrasonic cardiogram before and 3-10 months after implantation of pacemaker. Results The pacing leads were implanted successfully in RVOTS pacing group without any complication. As compared with baseline, during RVOT pacing, LVEF, FS, CO and CI were decreased by 3.46% ±3.89%,1.20%±2.47%,（0.19±1.32） L/min and （0.09±0.52） L.min^-1.m^-2 respectively （all P〉0.5）. As compared with baseline,during RVA pacing, LVEF, FS, CO and CI were decreased by 14. 27% ±5.83%, 8. 10% ±3.79%,（1.56±1. 11）L/min and（1.13 ±0.52）L.min^-1.m^-2 respectively （all P〈0.01）.Conclusions RVOTS pacing has no effects while RVA pacing has negative effects on hemodynamic parameters in patients implanted VVI pacemaker.