右室流出道间隔部与心尖部起搏对完全性CHB患者心功能的影响

Influence of right ventricular outflow tract septum pacing and right ventricular apical pacing on cardiac function in patients with complete atrioventricular block

目的:比较右室流出道间隔部(RVOTS)起搏与右室心尖部(RVA)起搏对完全性房室传导阻滞(CAVB)患者心功能的影响。方法:50例CAVB患者被随机分为RVOTS组(25例)和RVA组(25例),全部植入房室全能(DDD)型起搏器,分别观察术前,术后6个月、12个月的左室射血分数(LVEF)及左室短轴缩短率(FS)的变化。结果:所有患者以DDD模式或心房同步心室抑制(VDD)模式起搏,心室起搏比例为100%。所有患者均完成1年随访。术后6个月两组LVEF、FS无显著差异(P均>0.05);术后12个月,ROVTS组LVEF[(57.29±2.87)%比(50.03±2.98)%]、FS[(34.24±2.59)%比(29.06±3.72)%]显著优于RVA组(P均<0.05)。结论:右室流出道间隔部起搏的左室收缩功能显著好于右室心尖部起搏。

Objective： To compare influence of right ventricular outflow tract septum （RVOTS） pacing and right ven- tricular apex （RVA） pacing on cardiac function in patients with complete atrioventricular block （CAVB）. Methods： A total of 50 CAVB patients were randomly divided into RVOTS group （n = 25） and RVA group （n = 25）, and all patients were implanted with dual-chamber （DDD） pacemaker. Changes of left ventricular ejection fraction （LVEF） and left ventricular shortening fraction （FS） were observed in two groups before implantation, six months and 12 months after implantation. Results： Pacing model of all patients was DDD or atrial-synchronous ventricular- inhibited pacemaker （VDD）, and percentage of ventricular pacing was 100%. All patients completed one-year fol- low-up. There were no significant difference in LVEF and FS between two groups on sixth month after implantation （P〉0.05 both） ; on 12 th month after implantation, the LVEF and FS of ROVTS group were significantly higher than those of RVAgroup[LVEF （57.29±2.87） % vs. （50.03±2.98） %, FS （34.24±2.59） % vs. （29.06±3.72） %], P〈0.05 both. Conclusion： Left ventricular systolic function of right ventricular outflow tract septum pacing is significantly better than that of right ventricular apical pacing.