Ⅲ度房室传导阻滞患者行不同房室间期起搏对血流动力学及功能的影响

Association between different atrioventricular delay and cardiac hemodynamics and function in third degree atrioventricular block patients.

目的探讨Ⅲ度房室传导阻滞(AVB)患者不同房室间期(AVD)起搏对血流动力学及功能的影响。方法选择植入双腔起搏器的Ⅲ度AVB患者51例,按不同AVD分为前后4期:A期AVD为心房感知(SAV)90 ms、心室起搏(PAV)120 ms;B期为SAV 120 ms、PAV 150 ms;C期为SAV 150 ms、PAV 180 ms;D期为SAV 180 ms、PAV 210 ms。每期观察2个月,分别比较Ⅲ度AVB患者4期心电图QRS波时限和形态,血清氨基末端脑钠肽前体(NT-proBNP)水平及心脏超声左房内径(LAD)、左室收缩末期内径(LVDs)、左室舒张末期内径(LVDd)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左室射血分数(LVEF)及二、三尖瓣返流等参数。结果Ⅲ度AVB患者行不同AVD起搏时LAD、LVDd、LVDs、IVST、LVPWT及LVEF无变化;而二尖瓣及三尖瓣返流随AVD的延长而依次减少;起搏QRS波时限A期较D期长(149.21±8.10 ms vs 145.27±6.94 ms,P<0.05);NT-proBNP随AVD的延长而减少(中位值分别为365.51,327.54,279.13和270.10 pg/ml)。结论Ⅲ度AVD患者不同AVD起搏对心脏血流动力学会产生影响,短期内对心脏的结构及功能影响不明显,选择起搏间期为SAV180 ms、PAV 210 ms时患者的获益最大。

Objective To investigate the relationship between different atrioventricular delay（AVD） and cardiac hemo- dynamics and function in third degree atrioventricular block （AVB） patients with DDD pacing. Methods A total of 51 third degree AVB patients with dual-chamber pacemakers were divided into four phases A, B, C and D on different AVD after implantation of pacemakers. Phase A：AVD was SAV 90 ms,PAV 120 ms; Phase B：AVD was SAV 120 ms, PAV 150 ms;Phases C：AVD was SAV 150 ms,PAV 180 ms; Phases D：AVD was SAV 180 ms,PAV 210 ms. Each phase was ob- served for 2 months. The paced QRS duration, NT-proBNP levels and some echocardiographic parameters such as left atrial dimension （LAD） , left ventricular end-systolic dimension （ LVESD ）, left ventricular end-diastolic dimension （ LVEDD ）, in- terventricular septum thickness （IVST） ,left ventricular posterior wall thickness （LVPWT）, LVEF, the mitral valve and the mitral valve regurgitation were measured and analyzed at each phase. Results The LAD,LVEDD,LVESD,IVST,LVP- WT and LVEF had no difference in four phases;but the mitral valve regurgitation reduced with AVD increasment. The paced QRS duration in phases A was widened than in phase D dramatically（ 149.21 ±8.10 ms2 vs 145.27 ± 6.94 ms2 ,P 〈 0.05 ）. The level of NT-pro-BNP reduced with AVD increasing. Conclusion There is an association between different AVD and cardiac hemodynamics in third degree AVB patients with DDD pacing but there are no difference in cardiac struc- ture and function in the short tenn. The phase D （ AVD 180 ms and PAV 210 ms） maybe more effective than other phases.