右室流出道间隔部起搏与右室心尖部起搏对心功能影响的对比分析

Contrast study of effects on cardiac function between pacings of right outflow tract and right ventricular apex

目的比较右室流出道(RVOT)间隔部起搏和右室心尖部起搏(RVA)起搏对心功能的影响。方法将20例置入VVI/DDD起搏器的患者,随机分为2组,RVOT组行右室流出道间隔部起搏,RVA组行右室心尖部起搏;对比观察术前与术后心电图QRS波的宽度,比较2组术前与术后3个月随访的左室射血分数(LVEF)、左室短轴缩短率(FS)、心脏指数(CI)、每搏量(SV)、二尖瓣血流E峰和A峰最大充盈速度比值(E/A)的差异。结果RVA组起搏心电图QRS时限明显长于RVOT组〔(0.20±0.01):(0.12±0.02),P<0.01〕;术前2组LVEF、FS、CI、SV和E/A差异均无统计学意义。与术前相比,RVA组3个月随访的LVEF、FS、CI、SV和E/A均有所降低〔(61.4±6.5):(54.2±4.3)%,(30.5±3.1):(26.5±2.8)%,(2.69±0.31):(2.34±0.24),(83.6±9.7):(68.3±11.3),(1.76±0.47):(1.29±0.38),均P<0.05〕,RVOT组无明显变化〔(58.6±7.2):(57.7±6.8)%,(29.5±2.4):(28.7±2.1)%,(2.62±0.29):(2.59±0.28),(80.3±9.4):(79.6±9.1),(1.68±0.49):(1.66±0.48),均P>0.05〕。结论RVOT间隔部起搏较RVA起搏能保证心室正常的激动和收缩顺序,对左室收缩功能的影响小,是一种较为理想的起搏部位。

Objective To compare the effects on cardiac function between pacings of right outflow tract（RVOT） and right ventricular apex（RVA）.Methods Twenty patients undergoing VVI/DDD pacing were grouped randomly into two groups,one receiving RVOT pacing and the other RVA pacing.The QRS wave of ECG of the preoperation and postoperation were recorded and analyzed.The cardiac function parameters were compared between the two groups before and 3 months after operation.Results The QRS duration of RVA group was longer than that of RVOT group dramatically（（0.20±0.01）：（0.12±0.02）,P0.01）;There were no differences on LVEF,FS,CI,SV and E/A of the two groups before operation（P0.05）.Compared with the cardiac function of the preoperation,the LVEF,FS,CI,SV and E/A of the RVA groups 3 months after operation decreased significantly（（61.4±6.5）：（54.2±4.3）%,（30.5±3.1）：（26.5±2.8）%,（2.69±0.31）：（2.34±0.24）,（83.6±9.7）：（68.3±11.3）,（1.76±0.47）：（1.29±0.38）,P0.05）,while RVOT groups didn＇t change statistically（（58.6±7.2）：（57.7±6.8）%,（29.5±2.4）：（28.7±2.1）%,（2.62±0.29）：（2.59±0.28）,（80.3±9.4）：（79.6±9.1）,（1.68±0.49）：（1.66±0.48）,P0.05）.Conclusion RVOT pacing can keep the normal sequence of electrical activity and contrcation,with minor effect on left ventricular systolic function.It is an ideal pacing location.