右室心尖部与右室流出道起搏近期效果比较

A SHORT-TERM-EFFECT COMPARISON OF RIGHT VENTRICULAR OUTFLOW TRACT PACING WITH RIGHT VENTRICULAR APEX PACING

目的评价右心室流出道（RVOT）起搏和右心室心尖部（RVA）起搏对心脏同步性和心功能的影响。方法 41例病态窦房结综合征、高度及完全房室传导阻滞病人根据心室起搏电极植入部位的不同,分为RVOT起搏组（21例）和RVA起搏组（20例）。分别于术前和术后3、12个月通过超声心动图分别对病人左心室舒张末内径（LVEDD）,左心室收缩末内径（LVESD）、左心室射血分数（LVEF）、室间隔和左心室后壁之间的运动延迟（SP-WMD）、心室间机械延迟时间（IVMD）等指标进行观察随访。结果术后3、12个月时,RVOT起搏组的LVEDD、LVESDI、VMD和SPWMD均明显小于RVA起搏组,LVEF均明显高于RVA起搏组（t=2.14-12.61,P〈0.05）。结论 RVOT起搏较RVA起搏更有利于双心室电激动的同步性,且对心功能的不良影响较小。

Objective To assess the effects of right ventricular outflow tract（RVOT） pacing and right ventricular apex（RVA） pacing on cardiac synchronism and cardiac function. Methods According to the site of ventricular lead implanted,41 patients with sick sinus syndrome（SSS） or complete atrioventricular block（CAB） were divided into RVOT pacing group（21 patients） and RVA pacing group（20 patients）.Left ventricular end diastolic diameter（LVEDD）,left ventricular end systolic diameter（LVESD）,left ventricular ejection fraction（LVEF）,septum to posterior wall motion delay（SPWMD）,and the interventricular mechanical delay（IVMD） were measured by echocardiography,before and 3 and 12 months after implantation of the lead.Results Three and 12 months after the procedures,LVEDD,LVESD,IVMD and SPWMD in ROVT pacing group were significantly smaller than that in RVA pacing group,and LVEF was higher（t=2.14-12.61,P〈0.05）. Conclusion Compared with RVA pacing,RVOT pacing is more beneficial to the biventricular electrical synchronism and exerts less adverse effects on heart function.