右室间隔部起搏的部位选择与X线影像特点——简单方法确定起搏后QRS波尽可能窄的部位

Position selection and X-ray characteristics for the right ventricular septal pacing——a simple method to identify the site that can get narrow post-pacing QRS wave.

目的探讨右室间隔部不同部位起搏后QRS波时限与形态,并分析起搏后QRS波较窄处电极的X线影像特点与定位方法;方法将本院近期行右室间隔面起搏50例患者心室电极植入部位在X线后前位结合脊柱影分为高、中(距心影下缘1.5～2个椎体影)、低三部分,右前斜位(RAO)时将心影纵向均分为4区,并分析左前斜位(LAO)下电极的指向,不同部位起搏术中测试参数,起搏后QRS波形态,电轴,时限,术中、术后并发症以及随访中起搏器工作情况;结果所有电极LAO投照时均指向脊柱侧,RAO投照时电极头端位于心影3区(46支)或4区(4支),后前位下中位间隔组起搏后QRS波时限明显窄于高位和低位组(138±21 ms vs 162±20 ms,159±35 ms),电轴也较其他两组更接近于正常(40±35度)(P<0.05),3组术中测试参数与随访结果无差异。结论在间隔面距心影下缘1.5～2个椎体影高度处且RAO时头端位于3区者起搏后QRS波时限较窄,电轴较正常,植入简便安全。

Objective To analyze the post-pacing QRS morphology, width, X-ray characteristics at different right ven- tricular （RV） septal sites. Method The position of 50 pacing lead tips under X-ray. were divided into 3 parts （ high, middle and low） at posterioanterior position and 4 parts at right anterior oblique position. The direction of pacing lead tips at left anterior oblique position, electrical axis, the width of post-pacing QRS waves, .pacing parameters and complications at different septal sites were compared. Results All of 50 active pacing leads were implanted at different RV septal sites, the width of post-pacing QRS was narrowest at middle septal （ 138 ± 21 ms） , had significant difference compared with the other groups （ P 〈 O. 05 ）, and the electrical axis of QRS wave was 40 ± 35 degree. Conclusions The width of post- pacing QRS wave in the middle septum group is narrowest, and the morphology in this group is most likely the QRS that conducts through the His bundle.