右心室起搏部位对左心室收缩同步性的影响

Impact of right ventricular pacing sites on left ventricular systolic synchrony

目的评估右心室起搏部位对左心室收缩同步性的影响。方法植入DDD双腔起搏器的32例患者分为右心室心尖部起搏(DDDapx组,23例)和右心室间隔部起搏(DDDspt组,9例),另设正常对照组16例(C组)。比较术前及术后2周实时三维超声心动图(RT-3DE)图像相关参数。结果三组基线状态各项指标均无统计学差异(P>0.05)。DDDapx组术后左心室收缩不同步指数(SDI)、QRS起始点至左心室最小容积点的最大时间差(Tmax)均高于术前及C组(P<0.05)。术后DDDapx组的每搏输出量(SV)、舒张末期容积(LEDV)均低于DDDspt组和C组(P<0.05),而术后DDDspt组和C组的SDI、Tmax、SV和LEDV比较均无统计学差异(P>0.05)。DDDapx组术后左室射血分数与SDI和Tmax呈负相关(r=-0.536,r=-0.573,P<0.05)。结论 RT-3DE可以整体评价右心室不同部位起搏对左心室收缩同步性的影响。

Objective To evaluate the impact of right ventricular pacing sites on left ventrieular systolic synchrony. Methods DDD double chamber pacemakers were implanted in 32 patients, of whom pacing place located at right ventricular apex in 25 cases （group DDDapx）and at right ventricular septum in 9 cases（group DDDspt）. Sixteen healthy people were taken as the controls （group C）. The real-time three dimensional echocardiography（RT-3DE） images were taken before and two weeks after operation for evaluating the differences of left ventricular systolic synchrony. Results There were no differences in the baselines among three groups（P〉0. 05）. The systolic dyssynchrony index（SDI） and maximum time separation from QRS starting point to smallest volume of left ventricle （Tmax） in group DDDapx were higher after operation than those before and in group C（P〈0. 05）. The stroke volume（SV） and left ventricle end-diastolic volume（LEDV） after operation were lower in group DDDapx than those in group DDDspt and in group C（P〈0. 05）. There were no significant differences in SDI, Tmax, SV and LEDV after operation between groups of DDDspt and group C （P〉0.05）. Left ventricular ejection fraction was negatively correlated with SDI and Tmax （r=-0. 536, r=-0. 573, P〈0. 05）. Conclusion RT-3DE can overall evaluate the impact of right ventrieular pacing sites on systolic synchrony of the left ventricle.