VVI模式下右心室不同部位起搏对患者心功能的影响

The Impact on Cardiac Function in Patients at Different Parts of the Right Ventricle with VVI Mode

目的:比较在VVI模式下右心室间隔部起搏与右心室心尖部起搏对起搏依赖性患者心功能的影响。方法:26例慢室率房颤伴高度或Ⅲ度房室传导阻滞,10例窦律伴Ⅲ度房室传导阻滞,10例显著窦性心动过缓,6例窦性停搏伴交界性或室性逸搏,共52例患者,均植入VVI型心脏起搏器,按心室电极固定部位不同随机分为右心室间隔部起搏组(RVS组)和右心室心尖部起搏组(RVA组),随访6个月。应用超声心动图检查,观察两组术前与术后左室射血分数(LVEF);比较两组术前与术后血浆BNP变化。结果:术前两组LVEF及BNP水平差异无统计学意义。术后6个月随访LVEF,RVS组较RVA组有显著升高[(0.56±0.07)VS(0.44±0.12),P<0.01];检测BNP,RVA组较RVS组有显著升高[(121.8±5.2)pg/ml VS(57.1±6.6)pg/ml,P<0.01]。结论:RVS起搏比RVA起搏尽可能的维持了双心室激动顺序和双心室收缩同步性,对血流动力学及心脏功能的影响较小。

Objective：To explore cardiac function in pacemaker-dependent patients under the VVI mode in the right ventricular septum pacing compared with in the right ventricular apical pacing.Methods：Total 52 patients were implanted VVI type pacemaker： including 26 cases of atrial fibrillation with slow ventricular rate and high or Ⅲ degree atrioventricular block;10 patients with sinus rhythm and Ⅲ degree atrioventricular block;10 patients with significant sinus bradycardia;6 cases of sinus arrest with junctionalescapebeat.These cases were divided into the right ventricular septal pacing group（RVS group）and right ventricular apical pacing group（RVA group） according to the fixed parts of the ventricular electrode,and followed up for 6 months.Left ventricular ejection fraction（LVEF）was observed using echocardiography at preoperative and postoperative,plasma BNP changes were also compared at preoperative and postoperative.Results：BNP levels and LVEF at preoperative between the two groups were not significant statistically.After 6 months follow-up,LVEF in RVS group was significantly higher than that in RVA group[（0.56±0.07）VS（0.44±0.12）,P0.01];whereas BNP in RVA group was significantly higher than that in RVS group[（121.8±5.2）pg/ml VS（57.1± 6.6）pg/ml,P0.01].Conclusion：Pacemaking in RVS was helpful to maintain a dual ventricular activation sequence and biventricular systolic synchrony than that in RVA,and less affection on hemodynamics and cardiac function was occurred.