右心室高位间隔部与心尖部起搏对心功能影响的比较

Comparison of Effects on Cardiac Function between Pacing in Right High-interventricular Septum (RHIVS) and Right Ventricular Apex(RVA)

目的:对比右心室高位间隔部起搏(right high-interventricularseptum,RHIVS)与右心室心尖部(right ventricular apex,RVA)起搏对心功能的影响。方法:选取60例植入起搏器的患者,随机分为2组,30例行右心室高位间隔部起搏为RHIVS组,30例行右心室心尖部起搏为RVA组。比较两组术前及术后12个月的6分钟步行试验,术前及术后3个月、6个月、12个月的左室射血分数(left ventricular eject fraction,LVEF)。结果:RHIVS组与RVA组术前6分钟步行试验(six minute corridorwalktest,6-MWT)步行距离及LVEF无统计学差异。术后12个月,RVA组6-MWT步行距离较RHIVS组明显降低(310±95vs 415±103,P<0.01)。术后3个月、6个月及12个月,RVA组LVEF亦较RHIVS组有显著的减低(53.47±3.95 vs 56.25±4.73,P<0.05;52.17±3.68 vs 55.10±4.47,P<0.05;46.97±2.59 vs 53.95±4.84,P<0.01)。结论:右心室高位间隔部起搏防止起搏导致的心功能的恶化,改善患者的生活质量,更接近生理性起搏。

Objective To evaluate the cardiac function between RHIVS pacing and RVA pacing.Methods 60 patients with indications of pacing were divided into two groups randomly.Group A including 30 patients received RHIVS pacing while group B（30 cases） received RVA pacing.The distance of six minute corridor walk test（6-MWT） was compared before and 12 months after operation in both groups.The left ventricular eject fraction（LVEF） was also measured in two groups before and 3 months,6 months,12 months after operation.Results There was no significently differnce between two groups on the distance of 6-MWT and LVEF before operation.The distance of 6-MWT in RVA group was shorter than that in RHIVS group after 12 months operation（310±95 vs 415±103,P0.01）.LVEF was less decreased in RHIVS group than that in RVA group after 3 months,6 months,12 months operation（56.25±4.73 vs 53.47±3.95,P0.05;55.10±4.47 vs 52.17±3.68,P0.05;53.95±4.84 vs 46.97±2.59,P0.01）.Conclusions The RHIVS pacing can prevent deterioration of cardiac function and improve the quality of living after operation.Therefore,RHIVS pacing is more appropriate physiologic pacing.