最小化心室起搏与超声心动图指导下优化房室间期的比较研究

Comparison of the mode of minimization of pacing in ventricular and the mode of optimization of atrio-ventricular delay according to echocardiography

目的：比较最小化心室起搏模式（ MPV）与超声心动图指导下优化房室间期（ OAVD）模式对病态窦房结综合征伴房室阻滞患者心功能及生活质量的影响。方法2009年9月至2012年6月于杭州市第一人民医院心内科就诊的40例诊断为病态窦房结综合征伴一度或二度房室阻滞植入双腔起搏器的患者采用随机数字表法分为2组：MPV组21例患者,开启MPV功能；OAVD组19例患者,在超声心动图指导下进行OAVD。在入组6、12个月后给予起搏器程控、6 min步行试验、明尼苏达生活质量评分、血浆脑钠肽（ BNP）、超声心动图等检查。结果两组患者基线指标差异无统计学意义。 MPV组患者的起搏房室间期显著长于OAVD组[（278．6±9．6） ms对（131．9±5．1） ms,P＜0．001）。 MPV组患者心室起搏比例在6个月后明显低于OAVD组（6个月：28．6%±37．8%对77．4%±37．5%,P=0．001；12个月：39．0%±41．5%对84．7%±31．1%,P=0．001）。两组患者血浆BNP水平、6 min步行试验、明尼苏达生活质量评分及超声心动图指标均差异无统计学意义（ P〉0．05）。结论 MPV虽能够显著降低心室起搏比例,但是在改善心功能及生活质量方面与OAVD差异无统计学意义。

Objective To compare the effect of the mode of minimization of pacing in ventricular on heart function and quality of life with that of the mode of optimization atrioventricular delay according to echo-cardiography in patients with sick sinus syndrome and atrioventricular block. Method Forty patients who re-ceived pacemaker implantation for sick sinus syndrome and atrioventricular block were included in this study. Twenty-one patients were randomly assigned to minimization of pacing group（ MPV group） ,with the function of minimization of pacing. Nineteen patients were randomly assigned to optimization of atrioventricular delay group （ OAVD group） ,with atrioventricular delay optimized according to echocardiography. Program control of pace-maker,six-minutes walk test, Minnesota life quality score test, measurement of BNP and ultrasoundcardiogram were undertook at baseline,six months and twelve months later. Results There was no difference in baseline data between two groups. Sense atrioventricular delay was significantly longer in MPV group than that in OAVD group [（278. 6±9. 6） ms vs. （131. 9±5. 1） ms,P〈0. 001]. The ventricular pacing rate in MPV group was significantly lower than that in OAVD group after six month（6 month：28. 6%＋37. 8% vs. 77. 4%＋37. 5%,P=0. 001;twelve month：39. 0%±41. 5% vs. 84. 7%±31. 1%,P〈0. 001）. There was no difference in Minnesota life quality score, BNP and echocardiography data between two groups. Conclusion The mode of minimization of pacing in ventric-ular can significantly decrease ventricular pacing rate,but it did not improve heart function and life quality.