右室双部位起搏与双室同步起搏的急性血液动力学对比研究

The Comparison Study on the Acute Hemodynamic Effects of Right Ventricular Bifocal (RV-Bi) Pacing and Biventricular (BiV) Pacing.

比较右室双部位 (RV Bi)起搏和双室 (BiV)同步起搏对血液动力学的影响 ,并与右室心尖部 (RVA)、右室流出道 (RVOT)、左室基底部 (LVB)起搏相比较 ,明确双部位起搏是否优于单部位起搏。 15例患者中病窦综合征 8例、Ⅲ度房室阻滞 7例。分别行RVA、RVOT、LVB、RV Bi、BiV起搏 (VVI,6 0～ 90次 /分 ) ,测定心输出量 (CO)和心脏指数(CI)、肺毛细血管嵌顿压 (PCWP)和QRS波时限 (QRSd)。结果 :①与RVA起搏相比 ,RVOT、LVB、RV Bi、BiV起搏CI分别增加了 7.5 %、11.3%、15 .5 %和 17.2 % ,PCWP分别降低了 14.9%、10 .3%、2 1.7%和 2 0 .0 % (P均 <0 .0 1)。②RV Bi、BiV起搏较RVOT、LVB起搏的CO、CI增高而PCWP降低 (P均 <0 .0 5 )。③RV Bi与BiV起搏、RVOT与LVB起搏之间CO、CI和PCWP无显著差异。④RVOT、RV Bi、BiV起搏的QRSd(分别为 12 8± 11,111± 16 ,10 3± 13ms)较RVA起搏 (146± 18ms)时显著缩短 (P≤ 0 .0 0 1) ,而LVB起搏 (142± 15ms)与RVOT、RVA起搏时无显著差异。结论 :RV Bi起搏和BiV同步起搏的急性血液动力学效果无明显差异 ,但双部位起搏的效果明显优于单部位起搏 ;

To assess the potential value of right ventricular bifocal (RV Bi) pacing and Biventricular (BiV) pacing,and compare the acute hemodynamic effects associated with pacing the right ventricular apex (RVA),outflow tract (RVOT) and the left ventricular base (LVB) respectively,pacing the RVA and RVOT together (RV Bi) and the RVA and LVB simultaneously (BiV).Methods:This study included 15 pts (8 SSS,7 Ⅲ°AVB) undergoing pacemaker implantation.RVA,RVOT,LVB,RV Bi and BiV pacing at 60～90 ppm were done in VVI mode.CO,CI and PCWP were measured and ECG was recorded simultaneously for QRS duration (QRSd) detecting.Results:① Comparing to RVA pacing,CI increased by 7.5%,11.3%,15.5% and 17.2%,PCWP decreased by 14.9%,10.3%,21.7% and 20.0% when pacing at RVOT,LVB,RV Bi and BiV, P <0.01,respectively.② CO and CI of RV Bi and BiV pacing were higher than that of RVOT and LVB pacing,PCWP was lower, P <0.05,respectively.③There was no significant difference between RV Bi pacing and BiV pacing in CO,CI and PCWP.④The QRSd of RVOT (128±11 ms),RV Bi (111±16 ms) and BiV pacing (103±13 ms) was significant shortened compared with RVA pacing (146±18 ms), P ≤0.001.But there was no significant difference between LVB pacing (142±15 ms) and RVOT or RVA pacing.Conclusion:There is no significant difference between RV Bi pacing and BiV pacing,however the acute hemodynamic effects of dual sites pacing were much better than that of single site pacing.In addition,the QRSd during dual sites pacing is significant shorter than that of single site pacing.