左室功能和结构改变与心脏起搏器起搏比例的关系

Relationship between pacing proportion of cardiac pacemaker and changes of left ventricular function and structure

目的:探讨心脏起搏器起搏比例与左室功能和结构改变的相关性。方法:选择我院2008年2月至2009年2月收治的永久性心脏起搏器植入患者40例,回顾分析相关临床资料。结果:起搏器植入后远期(3～4年)左室射血分数(LVEF)呈下降趋势,左室收缩末容积(LVESV)、左室舒张末容积(LVEDV)呈增大趋势,各参数在置入前与远期比较无显著差异(P>0.05)。将起搏心搏数/总心搏数界值定为60%,按起搏心搏数比例高组(≥60%)及低组(<60%)两个组划分,起搏心搏数比例高组较低组LVEF[(49.2±14.1)%比(63.1±7.3)%]有明显降低,LVEDV[(120.7±69.8)ml比(65.4±10.9)ml]明显增大(P<0.05)。结论:心脏起搏器植入3～4年,左室出现功能和结构重塑,起搏心搏数比例越大,左室射血分数越低,左室越大。

Objective： To explore relationship between pacing proportion of cardiac pacemaker and changes of left ventricular function and structure. Methods： Clinical data of 40 patients undergoing implantation of permanent car- diac pacemaker, they admitted in our hospital from Feb 2008 to Feb 2009 were retrospectively analyzed. Results： After pacemaker implantation three to four years （long term）, there was decrease in left ventricular ejection frac- tion （LVEF） and increase in left ventricular end-systolic volume （LVESV） and left ventricular end-diastolic volume （LVEDV）, but there were no significant differences between before and after implantation （P〉0.05）. When crit- ical value of pacing heart rate （HR） /total HR was fixed as 60%, and patients were divided into high percentage of pacing HR group （≥60%, high pacing HR group,） and low percentage of pacing HR group （〈60%, low pacing HR group）. Compared with low pacing HR group, there was significant decrease in LVEF [ （63.1±7.3） % vs. （49.2 ± 14.1） %] and significant increase in LVEDV [ （65 group, P〈0.05 both. Conclusion： After implantation of 4±10.9） ml vs. （120.7±69.8） ml] in high pacing HR cardiac pacemaker three to four years, functional andstructural remodeling may occur in left ventricle. The higher percentage of pacing heart rate is, the more is for left ventricular ejection fraction reduction and left ventricular dilation.