右心室间隔部不同位置起搏QRS时限与心室收缩同步性的比较

COMPARISION BETWEEN DIFFERENT TIGHT VENTRICULAR SEPTUM PACING SITES ON QRS COMPLEX DURATION AND SYNCHRONY OF VENTRICULAR CONTRACTION

目的观察右心室间隔部（RVS）不同部位起搏QRS时限（QRSd）与心室收缩同步指标的不同,寻求最佳生理性起搏部位。方法选择63例行双腔起搏器植入术的病态窦房结综合征（SSS）病人,根据心室电极植入部位不同,分为高位组（20例）、中位组（25例）和低位组（18例）,于术前和DDD起搏24h后测量QRSd、二尖瓣环平均收缩峰速度（LV-Sm）、室间隔和左心室后壁之间的运动延迟（SPWMD）、室间机械延迟（IVMD）。结果与术前相比,DDD起搏24h后,各组QRSd、SPWMD、IVMD均明显增大（t=11.55～25.29,P〈0.05）;其中中位组QRSd最窄,IVMD、SPWMD最低,与其他两组比较差异有统计学意义（F=12.456～148.648,t=4.08～16.51,P〈0.05）。各组术后LV-Sm均有降低的趋势,但差异无统计学意义（P〉0.05）。各组△QRSd与△SPWMD、△IVMD均呈正相关（r=0.525～0.924,P〈0.05）。结论 RVS不同部位起搏均可导致心室电与机械活动同步性下降,二者下降程度呈正相关。中位间隔部可能为最理想的RVS起搏部位。

Objective To investigate the difference of different right ventricular septum（RVS）pacing sites on QRS complex duration（QRSd）and the index of synchrony of ventricular contraction and seek the best site of physiologic pacing. Methods Sixty-three patients with sick sinus syndrome scheduled for a permanent pacemaker implantation were divided into three groups as high-septum（20patients）,mid-septum（25patients）and low-septum（18patients）groups according to the ventricular electrode pacing site.The QRSd,average diastolic mitral annular velocity（LV-Sm）,interventricular mechanical delay（IVMD）and septal to posterior wall motion delay（SPWMD）were measured,analyzed and compared before pacemaker implantation and 24hours after programmed in DDD mode. Results QRSd,IVMD and SPWMD at all different RVS sites were significantly increased compared with the ones before the implantation（t=11.55-25.29,P〉0.05）.LV-Sm at all different RVS sites presented the trend of decreasing,but there was no significant difference between them（P〈0.05）.Compared between the three groups,QRSd,IVMD and SPWMD at midseptum were lowest,and shorter than other groups（F=12.456-148.648,t=4.08-16.51,P〈0.05）.The△QRSd was significantly related to△SPWMD and△IVMD（r=0.525-0.924,P〈0.05）. Conclusion All the sites of RVS can lead the electric and mechanical synchrony of ventricular contraction to decrease,and the two are positively correlated with regard to the extent of descent.Mid septum may be the optimal site for RVS pacing.