右心室流出道间隔部起搏对左心室功能的影响

Influence of right ventricular outflow tract septum pacing on left ventricular function

目的比较右心室流出道间隔部(RVOT)起搏与右心室心尖部(RVA)起搏的血流动力学差异;评估RVOT起搏技术的可行性与安全性。方法选择有永久起搏器置入适应证的患者75例。根据术者建议和患者意愿分为RVOT组(40例)和RVA组(35例)。所有房室传导阻滞及病窦综合征合并一度房室传导阻滞患者采用双腔起搏双腔感知触发抑制型起搏模式,心房颤动伴长间歇患者采用抑制型心室按需起搏模式。比较2组的血流动力学差异。结果 RVOT组的QRS波宽度较RVA组缩窄(23.2±28.7)ms,差异有统计学意义(P<0.01)。与RVA组比较,RVOT组LVEF、左心室短轴缩短率明显升高,左心室舒张末容积明显下降(P<0.05,P<0.01)。与术前比较,RVA组LVEF、左心室短轴缩短率明显下降,左心室舒张末容积明显升高,差异有统计学意义(P<0.01)。结论利用螺旋电极进行RVOT起搏可行且较为安全。RVOT起搏的血流动力学参数优于RVA。

Objective To compare the hemodynamic parameters between right ventricular outflow tract septal（RVOT） pacing and right ventricular apical（RVA） pacing;to explore the clinical feasibility and safety of the technique of RVOT pacing. Methods Seventy-five patients with indications of implantation of permanent pacemaker were selected. According to the recommendations and wishes of the patients,they were divided into RVOT group（40 patients） and RVA group（35 cases）. All of the patients with atrioventricular block and sick sinus syndrome with atrioventricular block were treated with dual chamber pacing mode. The patients with intermittent atrial fibrillation were treated with ventricular inhibited demand pacing mode. Hemodynamic parameters were compared between the 2 groups. Results The width of QRS wave in RVOT group was nar- rower than that in the RVA group, the difference E（23. 2 ± 28. 7） ms] was statistically significant （P 〈 0.01）. Compared with RVA group,LVEF and left ventricular fractional shortening were significantly increased, and left ventricular end diastolic volume was decreased in RVOT group,the difference was statistically significant （P 〈 0.05,P 〈0.01）. Compared with the pre- operative values, LVEF and left ventricular fractional shortening were significantly decreased,and left ventricular end diastolic volume significantly increased in RVA group,the difference was statistically significant （P 〈 0.01）. Conclusion The use of spiral electrodes RVOT pacing is feasible and relatively safe. The hemodynamic parameters of RVOT pacing are better than those of the RVA pacing.