不同部位起搏对心室同步性的影响

Different selective site pacing influence ventricular synchronization

目的应用组织多普勒方法随机对照研究右室流出道间隔部(RVOT)与右室心尖部(RVA)起搏对心室同步性的影响。方法缓慢心律失常病例128例,所有患者起搏器植入术后1、3和6个月定期随访,观察起搏参数、累积心室起搏百分比,组织多普勒评价心室同步性。结果RVOT组和RVA组QRS时限有差异(P<0.01)。随访6个月心室累计起搏数、起搏阈值及起搏感知差异无显著性(P>0.05)。术后随访第1、3和6个月,RVOT起搏组的同步指标明显优于RVA起搏组(P均<0.01);左室射血分数在RVA组有所降低,第6个月RVOT组的射血分数优于RVA组(P<0.05)。结论右室心尖部起搏导致心脏收缩不同步,损害左室功能。流出道间隔部起搏保持良好心脏收缩同步性,是较好的右室起搏部位。

[Objective] To compare the effects of RVOT （right ventricular outflow tract septum, RVOT） pacing and RVA （right ventrieular apex） on ventrieular synchronization by Tissue Doppler image and evaluate the improvement of RVOT pacing on CRT clinical effects. [Methods] 128 patients with bradyarrhythmia were randomly divided into two groups. All patients were regularly followed up on 1st month, 3rd month and 6th month after pacemaker implantation, including pacing parameter, accumulative ventrieular pacing percentage and synchronous indexes. [Results] QRS durations in RVOT group and RVA group were 0.14±0.04s and 0.16 ±0.03s （P 〈0.01）. There were no differences in pacing parameters between the two groups during 6 months follow-up （P 〉0.05）. All patients had not suffered from implantation complications. On 1st, 3rd and 6th month follow-up, left ventrieular synchronous indexes（SPWMD, IVMD, Ts-SD and TSI） were better in RVOT groups than thaose in RVA groups（P all〈0.01）; LVEF decreased in the RVA group and LVEF was significant different between RVOT and RVA group on 6th month follow-up （P 〈0.05）. [Conclusions] RVA pacing deteriorates ventricular synchronization and left ventricular function. RVOT pacing is a better pacing site with no adverse influence on ventricular synchronization.