心脏右侧DDD起搏对心功能和心室收缩同步性的影响

Effects of right atrial and ventricular DDD pacing on cardiac function and ventricular contraction synchrony

目的 用平衡法核素心室显像（equilibrium radionuclide angiography,ERNA）方法评价心脏右侧DDD起搏对心功能和心室同步性的影响。方法10例病态窦房结综合征或间歇二度房室阻滞患者植入DDD起搏器。患者植入起搏器后行ERNA检查,用程控仪调整起搏器参数,分别在起搏情况下和窦性心律情况下采集数据,通过半自动处理数据获得心功能参数,对采集的数据进行位相分析（Phase analysis）处理,了解心室激动顺序,计算出相角程（Phase shift）来评估心室激动的同步性。结果患者在起搏时,左心室1/3EF比窦性心律时明显减低[（0.23±0.06）对（0.28±0.05）,P=0.01]。位相分析显示起搏时右心室激动早于左心室,相角程增宽[（64.13±16.81）°对（52.88±9.26）°,P=0.007]。在窦性心律时心室激动顺序为从室间隔近端或左心室基底部向心尖方向扩散,起搏心律时心室激动顺序发生改变,从右心室心尖部向心底部和左心室扩散。结论 单纯右心室起搏增加心室不同步性,影响左心室收缩功能。

Objective To evaluate the effects of right atrial and ventricular DDD pacing on cardiac function and ventricular contraction synchrony by equilibrium radionuclide angiography. Method Ten patients with a right atrial and ventricular DDD pacemaker implanted underwent equilibrium radionuclide angiography. The scintigraphic data were obtained during sinus rhythm and pacing rhythm. Cardiac function parameters were obtained semimanually with an interval of 3 - 4 min between sinus rhythm and pacing rhythm to ensure stable hemodynamic states. Phase analysis was used to study ventricular activation sequence and ventricular synchrony. Results Left ventricular 1/3 EF decreased significantly during pacing compared with sinus rhythm [ (0.23 ± 0.06) vs (0.28 ± 0.05),P = 0.01]. Other cardiac function parameters and regional EF had a tendency of reduction, which had no statistical significance. Phase analysis showed that right ventricle activated earlier than left ventricle during pacing,and phase shift was significantly wider during pacing than during sinus rhythm [(64.13±16.81)°vs (52.88±9.26)°,P = 0.007].The activation of two ventricles occurred simultaneously during sinus rhythm, with the activation sequence from proximal septum or left ventricular base to the apex. The earliest activation during pacing occurred at right ventricular apex, which spread to the base and left ventricle. Conclusion Right ventricular pacing had a negative effect on left ventricular systolic function and reduced ventricular synchrony.