主动固定电极在右室中部间隔面起搏的临床应用

Clinical application of the active electrode lead in the middle of the right ventricular septal surfaces pacing

目的探讨右室中部间隔面起搏定位方法及对患者心功能的影响。方法对38例行心脏起搏器植入治疗的缓慢性心律失常患者随机分为右室流出道(RVOT)中部间隔组(18例)和右室心尖部(RVA)组(20例),观察两组患者手术一般情况,以及术后6个月的心电图、心脏彩超EF值和左心室舒张末期内径等指标变化。并将行右室间隔面起搏18例患者心室电极植入不同部位定位比较,在X线后前位结合脊柱影分为高、中(距心影下缘1.5-2个椎体影)、低三部分,右前斜位时将心影纵向均分为4区,并分析左前斜位下电极的指向,不同部位起搏术中测试起搏后QRS波形态,电轴,时限。结果术后随访6个月,RVOT组QRS波时限和左心室射血分数均优于RVA组,差异均有统计学意义(P<0.05)。间隔部所有电极左前斜位投照时均指向脊柱侧,右前斜位投照时电极头端位于心影3区或4区,后前位下中部间隔组起搏后QRS波时限明显窄于高位和低位组,电轴也较其他两组更接近于正常(P<0.05)。结论 RVOT中部间隔起搏较RVA起搏更符合"生理性"起搏的特点,对心功能及心电的不良影响也小于RVA起搏。在右室中部间隔面起搏,电极距心影下缘1.5-2个椎体影高度处且右前斜位时头端位于3区者起搏后QRS波时限较窄,电轴较正常。

【Objective】 Investigate the right ventricular central intervals face pacing positioning methods and on cardiac function in patients.【Methods】 38 routine hospital cardiac pacing of the Slow arrhythmia were randomLy divided into the RVOT group and the RVA group.Observed the patients the general situation in postoperative,and after 6 months of ECG,the heart colored supersonic EF value and the left ventrieular end-diastolic inner diameter were observed.The position of 18 pacing lead tips under X-ray were divided into 3 parts（high,middle and low）at posterioanterior position and 4 parts at right anterior oblique position.The direction of pacing lead tips at left anterior oblique position,electrical axis,the width of post-pacing QRS waves at different septal sites were compared.【Resluts】 The two groups were followed up for 6 months,RVOT group QRS wave duration and left ventricular ejection fraction were better than RVA group,the differences were statistically significant（P0.05）.All of 18 active pacing leads were implanted at different RV septal sites,the width of post-pacing QRS was narrowest at middle septal,had significant difference compared with the other groups,and the electrical axis of QRS wave was Close to normal（P0.05）.【Conclusion】RVOT pacing has more＂physiological＂pacing feature of the cardiac function than RVA and ECG is less than of RVA pacing in the adverse effects.The width of post-pacing QRS wave in the middle septum group is narrowest,and the morphology in this group is most likely the QRS that conducts through the His bundle.