右室起搏电极参数随诊及其对心功能的影响

目的通过比较右室间隔部起搏和右室心尖部起搏电极参数和心功能的变化趋势，选择更为有利的起搏方式。方法选取心尖部起搏21例和间隔部起搏21例，术时、12个月、24个月随诊，分别作心脏彩色多普勒超声检查，记录左室舒张末期内径（LVEDD）、左室射血分数（LVEF）、起搏心电图测量Ⅱ导联QRS波时限、抽血查氨基末端脑钠肽前体（NT-proBNP）、起搏器程控仪记录阈值、阻抗、R波感知进行比较。结果间隔部组比心尖部组QRS时限和电极阻抗小，随起搏时间延长QRS时限、NT-proBNP、LVEDD增加、LVEF（％）下降，心尖部组表现较为明显。结论间隔部起搏QRS波较窄，LVEF（％）下降缓慢、LVEDD（mm）和NT-proBNP（pg／m1）升高缓慢，与心尖部起搏比较，心室同步性好、可延缓心功能减退，是右室起搏较好的选择部位。

Objective To select a more favorable pacing mode through comparing the tendency of right septal pacing and right ventricular apical pacing electrode parameters and cardiac function. Methods Selecting and comparing apical pacing in 21 cases and septal pacing in 21 patients, the data was collected during surgery, 12 months postoperatively, 24 months postoperatively. Checking echocardiogram respectively. Recording the left ventricular end-diastolic diameter （ LVEDD ） , left ventricular ejection fraction （ LVEF ） , pacing ECG measurement II lead QRS duration, blood investigations amino-terminal pro-brain natriuretic peptide （ NT-proBNP ） , the pacemaker programmed instrument recorded threshold, impedance, R-wave sensing. Results Comparing with RVA group, ventricular septum group＇ s QRS time limit and electrode impedance were small. With longer time pacing, the QRS time limit, NT-proBNP and LVEDD are increased; and LVEF （ % ） was decreased, and at RVA group showed more obviously. Conclusion Septal pacing QRS complex is narrower, LVEF （ % ） decreases slowly. LVEDD （ mm ） and NT-proBNP （ pg/ml ） increased slowly. Comparing to apical pacing, Septal pacing synchronization can slow the heart dysfunction and it is the better choice for right ventricular pacing site.