右室心尖部起搏QRS波时限对心功能的影响

Effect of paced QRS duration on heart function in patients with right ventricular apical pacing

目的观察右室心尖部起搏患者起搏QRS波时限对心功能的影响。方法 76例因Ⅲ度房室阻滞而安装起搏器的患者根据起搏QRS波时限分为A组(pQRSd<190 ms)52例、B组(pQRSd≥190 ms)24例,术前及术后12个月、24个月检测血浆脑钠肽(BNP)水平,进行心脏多普勒超声检查(LAD、LVEED、LVESD、LVEF),以心衰事件为终点事件,并进行比较。结果术后12个月,与A组比较,B组LVEF明显降低(P<0.05),2组间LAD、LVEDD、LVESD、血BNP比较无显著性差异;术后24个月,与A组比,B组的LAD、LVSED、LVDED和血BNP明显增高(P<0.05或0.001),LVEF明显降低(P<0.001)。整个随访期间,B组比A组心衰再入院率增高,但无统计学差异。结论右室心尖部起搏QRS波时限的延长可致心脏功能的受损。

Objective It is to observe the effect of paced QRS duration on heart function in patients with right ventricular apical pacing .Methods 76 patients with Ⅲ°atrioventricular block receiving pacemaker treatment were enrolled and stratified to group A（pQRSd〈190 ms,n=52） and groupB（pQRSd≥190 ms,n=24）.The concentration of brain natriuretic peptide （ BNP） was determined , left atrial diameter （ LAD） ,left ventricular ejection fracetion （ LVEF） ,left ventricular end diastolic di-ameter（LVEDD）,left ventricular end systolic dimension （LVEDD） were measured by heart Dropper ultrasound before opera-tion and in 12-month and 24-month after implanting .The primary outcome was heart failure event during follow-up.The indexes mentioned above were compared respectively .Results At 12-month after implanting , LVEF of the patients in the group B de-creased significantly compared with that of groupA （P〈0.05）,other echocardiography paramenters and the concentration of BNP were not significantly different between the two groups （P〉0.05）.After 24-month,LAD, LVEDD, LVESD and the con-centration of BNP of group B increased significantly compared with that of groupA , LVEF of the patients in the group B de-creased significantly compared with that of group A （P〈0.001）.There was no significant difference in the incidence of heart failure event between two groups during 24-month follow-up.Conclusion The prolonged paced QRS duration has a detrimental effect on long-term cardiac function during RVA pacing in patients with atrioventricular block .