被动电极右室流入道间隔部起搏的远期稳定性观察

Long-term stability of passive electrode pacing on right ventricular inlet septum

目的探讨被动电极置于右室流入道间隔部起搏(RVIS)的远期稳定性。方法观察被动电极置于右室流入道间隔部起搏者82例(RVIS组)和电极置入右室心尖部起搏者53例(RVA组)患者远期电极的稳定性、起搏电压、电极阻抗、QRS波时限及血浆B型利钠肽(BNP)水平的变化。结果 RVIS电极稳定在位。RVIS组4 a后的电极阻抗增加明显,起搏电压和QRS波时限增加不明显;RVA组4 a后的电极阻抗、起搏电压明显增加,QRS波时限增加不显著;RVA组电极阻抗、起搏电压及QRS波时限较RVIS组增加更显著。血BNP水平,RVIS组仅术后3个月增加明显,RVA组术后血BNP水平在各观察时间点均显著增加;RVA组术后BNP水平较RVIS组增加更显著。结论被动电极右室流入道间隔部起搏长期随访显示电极位置及起搏参数稳定,对心脏功能的长期保护作用更明显。

Objective It is to investigate the long-term stability of passive electrode pacing on right ventricular inlet septum （RVIS）. Methods The changes of serum brain natriuretie peptide（BNP） , pacing voltage threshold, electrode impedance and QRS interval were observed in 82 patients （RVIS group） after ventricular was paced effectively on right ventricular inlet sep- turn and in 53 patients （RVA group） after ventricular was paced effectively on right ventricular apex. Results The ventricle was paced effectively using passive electrode on right ventrieular inlet septum. The electrode impedance in RVIS group increased significantly after 4, the pacing voltage threshold and QRS interval increased indistinctively. The pacing voltage threshold and electrode impedance in RVA group increased significantly after 4 years, the QRS interval increase was nonsignificant. In comparison with RVIS group ,the pacing voltage threshold, electrode impedance and QRS interval in RVA group had a significant increase. The level of serum BNP in RVIS group was significant increase after 3 month. There were significant increases in serum BNP level of RVA group at 3 month and 4 year. In comparison with RVIS group, the level of serum BNP in RVA had a significant increase. Conclusion Using passive electrode on right ventricular inlet septum, the electrode place and pacing parameters are more stable in long-term follow up, and the protection of cardiac function is more obvious.