实时三维超声心动图评价右室不同部位起搏对左室收缩同步性的近期影响

Acute impacts of right ventricular alternative site pacing on left ventricular systolic synchronicity by real time three dimensional echocardiography

目的应用实时三维超声心动图技术评价VVI单腔起搏器置入右室流出道间隔部(RVOT)和右室心尖部(RVA)对左室收缩同步性的近期影响。方法40例房室传导阻滞及心动过缓需置入VVI单腔起搏器的患者,按起搏部位的不同分为RVOT组(n=20)和RVA组(n=20)。观察并比较两组置入起搏器后1周的起搏参数;术前及术后1周左室收缩同步性和心功能等指标。结果术后1周,两组起搏阈值、感知阈值、电极阻抗以及心功能无差异(P>0.05),RVOT组左室同步性指标术前与术后无差异(P>0.05),RVA组左室同步性指标较术前升高,且RVA组较RVOT组明显升高(P均<0.05)。结论VVI单腔起搏右室不同部位,RVOT较RVA更接近生理情况。

Objective To explore the effects of VVI single-chamber pacemakers on electrical-mechanical synchronization of the right ventricular apex（RVA） pacing or the right ventricular outflow tract septal （RVOT） pacing by real time three dimensional echoeardiography（RT-3DE）. Methods Forty patients with atrial-ventricular block and bradycardia were divided into 2 groups： RVA pacing group and RVOT pacing group according to different pacing site. The pacing parameters, left ventricular systolic synchronicity and cardiac function were evaluated and compared between two groups. Seven days after implantation of the single chamber pacemakers, percent of 16,12 section standard deviation in time to minimal systolic volume（Tmsv 16-SD% , Tmsv 12-SD% ） and left ventrieular ejection fraction（LVEF） were measured by RT-3DE. Results By comparison of RVOT and RVA pacing at seven days after implantation of the single chamber pacemakers, there was no significant difference in pacing parameters and LVEF （P 〉 0.05）. However, Tmsv 16-SD% and Tmsv 12- SD% significantly increased in the RVA group（P 〈0.05 ） but not significantly difference in the RVOT group（ P 〉0.05 ）. Conclusions VVI single-chamber pacing right outflow tract is closely accordance with physiological pacing.