右心腔不同部位起搏的慢性血流动力学对比研究

Contrast Study of Chronic Hemodynamics During Different Site Pacing in the Right Cardiac Chambers.

比较右心耳 (RAA)、右室流出道 (RVOT)与右室心尖部 (RVA)起搏的慢性血流动力学效果 ,评价RVOT起搏的可行性。2 9例患者 ,9例RAA起搏、8例RVOT起搏、12例RVA起搏 ,分别在术前及术后 6 .11± 4 .0 1、5 .38± 2 .92、5 .5 0± 2 .88个月 ,用多普勒超声心动图观察右心腔不同部位起搏的慢性血流动力学参数 ,包括左室射血分数(LVEF)、左室内径缩短分数 (SF)、肺动脉瓣口峰值血流速度 (PV)、二尖瓣口E峰血流速度 (E)、A峰血流速度 (A)及比值 (E/A)。结果 :RAA起搏时 ,LVEF、SF分别下降为 4 .5 6 %± 3.71% ,3.33%± 2 .83% ,P <0 .0 5。RVOT起搏时 ,LVEF、SF、E/A分别下降为 6 .38%± 4 .6 9% ,4 .13%± 2 .75 % ,1.2 9± 0 .5 1,P <0 .0 1。RVA起搏时 ,LVEF、SF、PV、E、E/A分别下降为 1.4 2 %± 5 .32 % ,7.92 %± 3.96 % ,8.5 8± 11.33cm/s,8.17± 9.6 3cm/s,0 .2 7± 0 .2 9,P <0 .0 1或0 .0 5。A则上升为 7.91± 11.2 6cm/s(P <0 .0 5 )。RVOT起搏与RVA起搏相比LVEF、SF明显改善 (P均 <0 .0 5 ) ,且临床症状明显减轻 ;与右房起搏相比 ,E/A下降 (P <0 .0 5 ) ,其他指标在随访期内未显示出统计学意义上的差别。结论 :对于心功能较好的患者 ,右心腔不同部位起搏对慢性血流动力学均有一定程度的负面影响 ;

Cardiovascular Department,the First Affiliated Hospital of Jiangxi Medical College,Nangchang,Jiangxi 330006,ChinaThe purpose of the study is to evaluate the effect of chronic hemodynamics during right atrial appendage(RAA) pacing,right ventricular outflow tract(RVOT) pacing or right ventricular apex(RVA) pacing,and to investigate the practicability of RVOT pacing.Hemodynamic parameters,including left ventricular ejection fraction (LVEF),shortening fraction of left ventricular inner diameter(SF),peak velocity of pulmonary valve(PV),E peak(E) and A peak(A) velocity of mitral valve,and ratio between E and A(E/A),were assessed by Doppler echocardiogram in 29 patients,9 of whom received permanent pacing in RAA,8 in RVOT,12 in RVA.Chronic data were collected 6.11±4.01,5.38±2.92 or 5.50±2.88 months respectively after pacemakers implanted.Results:During RAA pacing,LVEF and SF decreased 4.56%±3.71%,3.33%±2.83% respectively, P <0.05;During RVOT pacing,LVEF,SF and E/A decreased 6.38%±4.69%,4.13%±2.75%,1.29±0.51 respectively, P <0.01;During RVA pacing,LVEF?SF?PV?E and E/A decreased 1.42%±5.32%,7.92%±3.96%,8.58±11.33 cm/s,8.17± 9.63 cm/s,0.27±0.29 respectively, P <0.01 or 0.05;while A increased 7.91±11.26 cm/s, P <0.05.RVOT pacing resulted in both LVEF and SF improvement (all P <0.05) and clinical amelioration compared with RVA pacing,but resulted in E/A declined compared with RAA pacing( P <0.05),while other hemodynamic parameters had no significant difference within the follow up periods.Conclusions:To those who having mild left ventricular dysfunction,chronic findings indicated that hemodynamic parameters deteriorated in all pacing site,especially in RVA.Compared with traditional RVA pacing,RVOT pacing may significantly improve both hemodynamics and clinical condition.