高度房室传导阻滞患者主动导线在右心室流出道间隔部起搏的研究

Clinical study of active conductor right ventricular outflow tract pacing in patients with high degree atrioventricular block

目的观察高度房室传导阻滞患者行右心室流出道间隔部(RVOT)主动导线起搏和右心室心尖部(RVA)被动导线起搏方式对远期心脏功能的影响。方法回顾分析2007年1月～2010年1月于我院植入DDD起搏器的66例高度房室传导阻滞患者。其中RVA被动导线起搏组33例,RVOT主动固定导线起搏组33例。比较两组术中手术时间、X线曝光时间、QRS波宽度。术后随访观察的时间为植入后第1、3、6、12个月及以后每半年1次,随访内容为心脏彩超、体表心电图及患者NYHA心功能分级并与安装起搏器之前进行比较。结果两组均顺利完成手术,未出现严重并发症。术后随访19～42个月。主动导线组手术时间较被动导线组长[(73.45±11.21)min vs(68.34±11.43)min,t=2.12,P<0.05)];X线曝光时间较被动导线组长[(9.13±3.04)min vs(7.11±2.21)min,t=3.58,P<0.01)]。主动导线组QRS波宽度明显窄于被动导线组[(0.11±0.03)s vs(0.20±0.04)s,P<0.05]。植入起搏器后第12个月患者NYHA心功能分级,被动导线组为(2.02±0.13)级,较术前无明显变化;主动导线组为(2.68±0.19)级,两组差异有统计学意义(P<0.01)。结论右室间隔部主动导线起搏对患者远期心功能影响较小。

Objective To observe the impact of long-term cardiac function in patients with high degree atrioventricular block between the active conductor way of right ventricular outflow tract（RVOT） pacing and negative conductor way of right ventricular apical pacing.Methods 66 cases of high degree atrioventricular block receiving DDD pacemaker implantation in the hospital from January 2007 to January 2010 were retrospectively analyzed.33 cases were given right ventricular apical pacing（RVAP） with passive electrode and the other 33 cases were given RVOTP with active fixation electrodes.Operating time,X-Ray exposure time,and QRS wave were analyzed retrospectively.Patients were followed up 1,3,6 and 12 months after implantation and subsequently once half a year.Echocardiography,surface ECG and NYHA classification were followed up and the results were compared with those before pacemaker implantation.Results Both groups were successfully in surgery without serious complications.The patients were followed up for 19-42 months.Operating time was longer in the active conductor group than in the passive conductor group [（73.45±11.21） min vs（68.34 ± 11.43） min,t = 2.12,P 〈0.05）].And X-Ray exposure time in active conductor group was also longer than in passive conductor group [（9.13±3.04） min vs（7.11±2.21） min,t = 3.58,P 〈0.01）].QRS wave was significantly narrower in active conductor group than in passive conductor group [（0.11±0.03） s vs（0.20±0.04） s,P 〈0.05）].12 months after pacemaker implantation,NYHA classification of the passive conductor group was（2.02±0.13） degree,showing no significant improvement.NYHA classification of the active conductor group was（2.68±0.19） degree and was better than that of passive conductor group,the difference was statistically significant（P 〈0.01）.Conclusion Active conductor of RVOTP has comparatively less impaction of long-term heart function of patients.