Ⅲ度房室传导阻滞患者高位右室间隔部起搏VAT与DDD模式对左心功能的影响

Effects of VAT and DDD pacing on left cardiac function in the patients of high right ventricular septal pacing with third degree atrioventricular block.

目的通过研究Ⅲ度房室传导阻滞患者高位右室间隔部起搏(HRVS)时,VAT与DDD模式对心功能的影响,探讨心房的生理收缩和舒张对左心功能的作用。方法 32例Ⅲ度房室传导阻滞患者,在HRVS时,分别给予DDD模式或VAT模式工作,于调控即刻通过超声心动图测定二尖瓣口快速充盈期峰值血流速度(Ep),二尖瓣口左房收缩期峰值血流速度(Ap),二尖瓣环后壁处收缩期脉冲组织多普勒峰值速度平均值(Vs),二尖瓣环后壁处舒张早期脉冲组织多普勒峰值速度平均值(Ve),二尖瓣环后壁处舒张晚期脉冲组织多普勒峰值速度平均值(Va),二尖瓣血流频谱等容舒张时间(IVRT),通过Ep/Ap,Ve/Va,Ep/Ve和IVRT评价左室舒张功能,通过Vs,LVEF和LVFS评价收缩功能。结果 HRVS时DDD较VAT模式Ep/Ap、Ve/Va、Ep/Ve,IVRT差异有显著性(0.97±0.11 vs 1.01±0.11,0.89±0.09 vs 0.97±0.07,6.00±0.45 vs 6.24±0.36,100.4±14.32 vs 89.99±7.94;P均<0.01),Vs、左室射血分数和左室短轴缩短率无显著性差异。结论Ⅲ度房室传导阻滞时,HRVS起搏时,DDD模式较VAT模式使左室舒张功能下降,收缩功能无影响,表明了心房生理性起搏的重要性。

Objective To analyze the effects of physiologic systole and diastole of atrium, through the influence of VAT and DDD pacing mode on left cardiac function in patients of high right ventrieular septal（HRVS） pacing with third degree atrioventricular block. Methods Thirty-two patients of HRVS pacing with third degree atrioventricular block with pace- maker mode of VAT or DDD underwent complete standard echocardiography （2D, M-mode, pulsed Doppler） and PW-DTI. Transmitral inflow velocity Ep and Ap, peak systolic velocity （ Vs）, peak early diastolic velocity （Ve） , peak late diastolic velocity （Va） of posterior mitral annulus and the isovolumic relaxation time（IVRT） were obtained . Then left ventricular diastolic function were evaluated through Ep/Ap, Ve/Va and Ep/Ve ratio and IVRT, and left ventricular systolic function were evaluated through Vs, LVEF and LVFS. Results Indexes of LV diastolic function： the ratio Ep/Ap, Ve/Va and Ep/Ve between DDD and VAT mode in HRVS were all significantly different（0.97 ±0.11 vs 1.01±0.11,0.89±0.09 vs 0.97 ±0.07,6.00± 0.45 vs 6.24 ± 0.36,100.4± 14.32 vs 89.99 ± 7.94 ;P 〈 O. 01 ） ; but no significant difference in in- dexes of LV systole function ： Vs, LVEF and LVFS between DDD and VAT mode in HRVS （ P 〉 0.05 ）. Conclusion LV diastolic dysfunction in DDD mode with HRVS pacing is more severe than VAT mode, and happened earlier than systol- ic dysfunction. These results indicate the importance of physiologic pacing of atrium.