右室间隔部起搏对心衰犬心室同步性及心功能的影响

Effects of right ventricular septal pacing modes on acute cardiac function and ventricular synchronization in dogs with heart failure

目的评价右室间隔部起搏方式纠正心衰的疗效。方法12只心衰犬，采用自身对照方法随机行右心房-右室心尖部（RVA）、右心房一右室间隔部（RVS）、右心房．双室（Bi—V）起搏，每种方式起搏前及起搏稳定15min后行彩色多普勒超声心动图检查，测定左心室舒张末期直径（LVEDd）、左室射血分数（LVEF）、室间机械延迟（IVMD）、室间隔与左室后壁运动延迟（SPWMD）、左心室12个节段达峰时问的标准差（Ts—sD）。结果右室间隔部起搏时：（1）与起搏前及右室心尖部起搏相比，LVEDd、IVMD、SPWMD、Ts—SD减小，LVEF增加，差异有统计学意义（P〈0．05）。（2）与双室起搏相比，LVEDd、IVMD、SPWMD、Ts—SD增加，LVEF减小，差异有统计学意义（P〈0．05）。结论右室间隔部起搏一定程度上改善了心室的同步性及心功能，疗效优于右室心尖部但不及双室起搏，还不能成为心脏再同步化治疗（CRT）心衰的备选模式。

Objective To evaluate effects of right ventricular septal pacing modes on treatment of heart failure. Methods Twelve dogs with heart failure were performed in every dog at random, and the pacing modes employed in the test included right atrium-right ventricular apex （ RVA）, right atriumright ventricular septal（ RVS）, and right atrium- biventricular （Bi-V） ; The pacing frequency was 180 times per minute. The results were measured before pacing and after 15 minutes when the pacing became stable in Color Doppler echocardiography, including left ventricular end-diastolic diameter （LVEDd）, left ventricular ejection fraction （LVEF）, interventricular mechanical delay （IVMD）, interventricular septum and left ventricular posterior wall motion delay （ SPWMD ）, and left ventricular 12-segment peak time standard deviation （Ts-SD）. Results Right ventricular septal pacing mode： （1）Compared with parameter before pacing and RVA pacing, LVEDd, IVMD, SPWMD, and Ts-SD decreased and LVEF increased, and the difference was significant（ P 〈0.05）. （2）Compared with Bi-V pacing, LVEDd, IVMD, and SPWMDandTs-SD increased and LVEF decreased , and the difference was significant （ P 〈 0. 05）. Conclusions Right ventricular septal pacing could improve ventricular synchrony and cardiac function partly, and the effect was better than right ventricular apical pacing but less than biventricular pacing, also could not be a alternative models of cardiac resynchronization therapy for heart failure.