右室流出道起搏与右室心尖起搏QRS波对比研究

Comparison of QRS in patients with right ventricular outflow tract septal pacing and right ventricular apical pacing

目的评估右室间隔部起搏与右室心尖起搏的效果。方法将96例起搏器植入患者分为右室心尖起搏组(58例)与右室流出道间隔起搏组(38例),其中流出道间隔起搏组又分为高位间隔组(25例)和低位间隔组(13例)。测量各组术前、术后完全起搏的QRS时限(QRSd)、术后完全起搏的QRSd与术前QRSd的差值(ΔQRSd)。结果右室流出道间隔起搏组完全起搏时QRSd短于右室心尖起搏组[(139±8.6)ms vs(156±15.4)ms,P<0.001],右室流出道间隔起搏组ΔQRSd<右室心尖起搏组[(39±10.9)ms vs(57±13.2)ms,P<0.001]。高位间隔组与低位间隔组术后、术前QRSd、ΔQRSd均无统计学差异(P>0.05)。结论右室流出道间隔部起搏比右室心尖起搏更接近生理性起搏。

Objective To evaluate the different effect between right ventricular apical pacing and right ventricular outflow tract septal pacing by comparing QRS duration.Methods 96 patients with permanent pacemaker implantation were divided into right ventricular apical group（58 cases） and right ventricular outflow tract septum group（38 cases） according to the ventricular lead placement.The right ventricular outflow tract septum group were divided into high septum group（25 cases） and low septum group（13 cases）.The QRS duration（QRSd） before and after pacemakers implantation,and the difference in QRS duration（ΔQRSd） were measured.Results After pacing,the mean QRSd of right ventricular outflow tract septum group was significantly shorter than right ventricular apical group[（139±8.6） ms vs（156±15.4） ms,P0.001].TheΔQRSd of right ventricular outflow tract septum group was significantly shorter than right ventricular apical group[（39±10.9） ms vs（57±13.2） ms,P0.001].The mean QRSd before and after pacing and theΔQRSd were similar between high septum group and low septum group.Conclusion The right ventricular outflow tract septal pacing is more physiological than the right ventricular apical pacing.