心室激动顺序对犬左室舒缩功能的影响

The effect of ventricular activation sequence on left ventricular function in dogs

目的通过设立心室激动顺序正常或异常的４种起搏方式，观察心室激动顺序异常引起的左室收缩和舒张功能变化。方法选用健康犬１０只，随机顺序进行右房－希氏束顺序起搏、右房右室顺序起搏、希氏束近端起搏和右心室起搏，在每种起搏稳定３分钟后测定有关血液动力学参数。结果右房－右室顺序起搏与右房－希氏束顺序起搏比较，心输出量（ＣＯ）、等容收缩期左室压力最大上升速率（＋ｄｐ／ｄｔｍａｘ）和等客舒张期左室压力最大下降速率（－ｄｐ／ｄｔｍａｘ）均降低，左室松驰时间常数（Ｔ）增加；右心室起搏与希氏束近端起搏比较，ＣＯ、＋ｄｐ／ｄｔｍａｘ和－ｄｐ／ｄｔｍａｘ均降低，Ｔ增加。结论心室激动顺序异常可以影响左室收缩和舒张功能，在人工心脏起搏治疗中，保持正常的心室激动顺序具有重要意义。

Objective To observe the change of left ventricular systolic and diastolic function by usingfour pacing modes which produced normal or abnormal ventricular activation sequence. Methods Four pacingmodes, including AHSP, AVSP, HBP and RVP, were performed in 10 dogs at random and hemodynamicparameters were measured after each pacing mode was stabilized for 5 minutes. Results Compared to AHSP,AVSP showed a decrement of CO, +dp/dtmax and-dp/dtmax, and an increment of T compared to HBP, RVPshowed a decrement of CO, +dp/dtmax and -dp/dtmax and an increment of T. Conclusion Abnormal ventricularactivation sequence can deteriorate left ventricular systolic and diastolic function. Thus it is important to preservenormal ventricular activation sequence in cardiac pacing.