食管心电图在优化双腔起搏器房室间期中的价值

The application of esophageal electrocardiography in optimizing atrioventricular delay for dual-chamber pacemaker

目的 探索用食管心电图优化双腔起搏器房室间期.方法 选择2008年1月至2014年3月因高度或Ⅲ度房室传导阻滞、双结病变在我院植入起搏器的患者22例,男性13例,女性9例,平均年龄（61±12）岁.同步记录食管心电图与体表心电图,测量出房间传导时间,在此基础上加100 ms,设定为优化后起搏器的房室间期.每例患者分别在出厂时设定的房室间期和根据食管心电图优化后的最佳房室间期（AV间期）下进行超声心动图检查,比较血流动力学指标.结果 当采用经食管心电图优化后的最佳房室间期时,患者的左室收缩末期容积（LVESV）、左室舒张末期容积（LVEDV）及左室射血分数（LVEF）等指标均显著优于常规出厂设置的房室间期下所测量的值[（35.18±7.33）ml比（34.32±7.14）ml;（83.98±12.63）ml比（84.71±12.90）ml;（57.99±6.90）％比（59.30±6.95）％,P均＜0.05],差异有统计学意义.结论 通过食管心电图可测量出患者的房间传导时间,根据数值进行个体化的房室间期的优化,使患者得到良好的血流动力学效果.该方法无创、简便易行,适合临床广泛应用.

Objective To investigate optimization AV delay adjustment with esophageal electrocardiogram. Methods DDD pacemakers were implanted in 22 patients with complete, or almost complete AV block from January 2008 to March 2014. Optimal AV delay was achieved by programming an additional delay of 100 ms to the inter-atrial conduction time, which measured by Esophageal and surface ECG. Left ventricular （LV） end diastolic and end systolic volumes, ejection fraction and diastolic parameters were measured by Doppler eehocardiography during both nominal and optimal AV delay pacing. Results Compared to nominal AV delay setting, LV end systolic volume significantly decreased [（35.18±7.33）ml vs （34.32±7.14）ml, P〈0.05], end diastolic volume signifieantly increased [ （83.98±12.63）ml vs （84.71±12.90）ml, P〈0.05 ], and resulting in an significantly increase in LV ejection fraction[（57.99±6.90）% vs （59.30±6.95）%, P〈0.05]. LV diastolic filling and isovolumic relaxation time were not significantly changed. Conclusion Optimization of AV delay by Esophageal ECG is a effective method to improve LV systolic function during dual chamber pacing.