右心室高位室间隔起搏与右心室心尖部起搏的临床对照研究

A comparative study between right high-interventricular septal pacing and right ventricular apex pacing

目的:探讨右心室高位室间隔起搏与右心室心尖部起搏对血流动力学的影响。方法:右心室高位室间隔起搏组20例,右心室心尖部起搏组20例,分别于术前、术后3个月行心电图、超声心动图检查,术中测定起搏参数及曝光时间。结果:2组在起搏阈值、感知、阻抗,电极脱位率方面差异均无统计学意义,右心室高位室间隔起搏组手术曝光时间长于右心室心尖部起搏组。与后者比较,右心室高位室间隔起搏组起搏后QRS波宽度变窄,射血分数、每搏量明显增大,差异有显著性。结论:右心室高位室间隔起搏更接近生理性起搏,血流动力学更好,可能是一个更佳的起搏部位。

Objective：To explore the different influence of hemodynamics between right high-interventricular septal pacing（RHIVSP）and right ventricular apex pacing（RVAP）.Method：A total of 40slow arrhythmic patients with indications of pacing was divided into RHIVSP group and RVAP group randomly.Twenty patients in RHIVSP group received permanent pacing in right high-interventricular septum,while RVAP group received permanent pacing in right ventricular apex.Electrocardiogram and echocardiogram were executed before pacemakers implantation and after the operation for 3months.The pacing parameter and time of exposure in the operation were also demanded.Result：The pacing threshold value,sensation,Impedance,ratio of electrodes dislocations were no differences between two groups.The time of exposure in RHIVSP group was longer than RVAP group.Compared with RVAP group,the duration of QRS was shorter,and the left ventricular ejection fraction and stroke volume were apparently bigger in RHIVSP group.Conclusion：Compared with RVAP,RHIVSP is more appropriate for physiologic pacing,which suggested that right high-interventricular septal is better pacing site.