右室起搏对心室同步性及P波离散度的影响

Influence of right ventricular apical pacing or right ventricular outflow tract pacing on ventricular synchronism and P wave dispersion

目的比较右室心尖部或流出道起搏对心室同步性及P波离散度的影响。方法对60例因病态窦房结综合征(SSS)或房室传导阻滞(AVB)需行永久起搏器植入术(VVI或DDD)患者,根据起搏部位,选择右室心尖部(RVA)起搏组(n=32,男15,女17),右室流出道(RVOT)起搏组(n=28,男14,女14)。追踪术前、术后(18±7)个月两组心电图P波离散度(Pd)、最大P波时限(Pmax)、QRS波时限变化、左房容积指数(LAVI)、主动脉射血前间期(APEI)与肺动脉射血前间期(PPEI)差值来评价起搏对心室同步性及心房电活动影响程度。结果与术前相比,两组Pd、Pmax、QRS、LAVI均明显增加,但RVA组Pd、Pmax、LAVI及QRS时限增量变化较RVOT大,P<0.05。与RVA组相比,RVOT组APEI-PPEI差值及LAVI较小,P<0.01。结论 (1)与RVA相比,RVOT起搏心室间电激动与机械收缩更同步;(2)右室起搏可致心房的电生理紊乱,导致Pd、Pmax的增大;(3)与RVA相比,RVOT起搏对心房电活动影响小。

Objective To investigate the effects of right ventricular apical pacing or right ventricular outflow tract pacing on ventricular synchronism and P wave dispersion.Methods 60 patients who had atriventricular block（AV block）or sick sinus syndrome（SSS）were implanted DDD or VVI pacemaker.RVA pacing was conducted in 32 patients（15 males and 17 females）and RVOT pacing was conducted in 28 patients（14 males and 14 females）.The changes of APEI-PPEI,QRS duration,Pd,Pmax,LAVI were compared between pre-implantation and 18±7 months after installment of the pacemakers to evaluate the influence of pacing on ventricular synchrony and atrial electrical physiology.Results Compared with pre-implantation,the QRS duration,Pd,Pmax,LAVI were significantly changed after ventricular pacing both in RVA pacing and RVOT pacing（P0.05）.But the increment in RVA pacing was more than RVOT pacing.Compared with RVA pacing,RVOT pacing was less in APEI-PPEI（P0.01）.Conclusion RVOT pacing can provide better ventricular synchronization than RVA pacing.Right ventricular pacing may lead to atrial electrophysiological disorder,leading to Pd and Pmax increases.RVOT pacing affects fewer atrial electrical activities than RVA pacing.