右室流出道间隔部与右室心尖部起搏对老年病态窦房结综合征患者左室功能影响的对比研究

Right Ventricular Outflow Tract Septum Pacing and Right Ventricular Apical Pacing: A Comparative Study of Their Effects on Left Ventricle Function in Old Patients with Sick Sinus Syndrome

目的：对比右室流出道（ RVOT）间隔部起搏与右室心尖部（ RVA）起搏对老年病态窦房结综合征（ SSS）患者左室功能的影响。方法回顾性分析2012年3月-2013年3月在松江区中心医院诊断为SSS的老年患者65例，其中男40例，女25例；年龄62～76岁，平均（70.6±10.8）岁。依据右室起搏部位的不同，分为RVOT间隔部起搏组（33例），RVA起搏组（32例）。比较两组起搏器植入术前、术中与术后6个月QRS波时限，术前与术后6个月左室功能指标〔左心室舒张末期内径（ LVEDD）、左心室收缩末期内径（ LVESD）与左心室射血分数（ LVEF）〕，术后6个月两组累计右室起搏百分比。结果 RVOT间隔部起搏组与RVA起搏组术中、术后6个月QRS波时限与术前比较，差异均有统计学意义（ P﹤0.05）。术前两组QRS波时限比较，差异无统计学意义（ P﹥0.05）；术中与术后6个月RVOT间隔部起搏组QRS波时限短于RVA起搏组（ P﹤0.05）。术后6个月RVOT间隔部起搏组累计右室起搏百分比为（56±44）%，RVA 起搏组为（53±46）%，两组间差异无统计学意义（ t ＝0.735，P ＝0.962）。术前两组LVEDD、LVESD、LVEF比较，差异无统计学意义（P﹥0.05）；术后6个月RVA起搏组LVEDD大于RVOT间隔部起搏组，LVEF低于RVOT间隔部起搏组（ P﹤0.05）。RVOT间隔部起搏组LVEDD、LVESD、LVEF术后6个月与术前比较，差异无统计学意义（P﹥0.05）；RVA起搏组LVEDD术后6个月大于术前，LVEF术后6个月低于术前（P﹤0.05）。结论 RVOT间隔部起搏对老年SSS患者左室功能的保持优于RVA起搏，为临床选择起搏位点提供了参考依据。

Objective To explore the effects of right ventricular outflow tract （RVOT） septum pacing and right ventricular apex on left ventricle function in elderly patients with sich sinus syndrome （SSS）. Methods The data of 65 SSS elderly patients, including 40 males, 25 females, aged 62 -76 years, meanly （70. 6 ± 10. 8） years old, admitted to Department of Cardiology, Central Hospital of Songjiang District from March 2012 to March 2013 were analyzed retrospectively, and divided, according to sites of right ventricular pacing, into groups RVOT （ n = 33 ） , RVA （ n = 32）. QRS wave time limit before, during operation, 6 months after operation, left ventricle function indicators [ left ventricular end diastolic diameter （ LVEDD）, left ventricle end systolic diameter （ LVESD ）, left ventricular ejection fraction （LVEF） ] before operation and 6 months after operation, accumulative total right ventricular pacing percentage 6 months after operation were compared between 2 groups. Resuits The QRS wave time limit after operation was significantly different from that 6 months after operation between 2 groups （P 〈 0. 05 ）. There was no difference in QRS wave limit between 2 groups （ P 〉 0. 05 ）, QRS wave limit was shorter in group RVOT than in RVA group during operation, 6 months after operation （ P 〈 0. 05 ）. Accumulative total right ventricular pacing percentage of RVOT group was （56 ±44） % , that of RVA group was （53 ± 46） % 6 months after operation, the difference was not significant （t = 0. 735, P = 0. 962）. There was no difference in LVEDD, LVESD, LVEF between 2 groups before operation （P 〉0. 05）. LVEDD was greater, LVEF lower in RVA group than in RVOT group 6 months after operation （P 〈0. 05）. There was no difference in LVEDD, LVESD, LVEF between pre - operation, 6 months after operation in RVOT group （ P 〉 0. 05）.LVEDD was greater, LVEF lower 6 months after operation than before operation in group RVA （P 〈 0. 05）. Conclusion RV- OT is superior to RVA in protection of left ventricle function, which provides a basis for ctinical choice of pacing sites.