右室间隔起搏与右室心尖起搏对心室同步性及心功能影响的临床研究

The influence of right ventricular septal and apex pacing on ventricular synchony and function

目的:经胸CT确定心室电极位置,分析右室间隔起搏与心尖起搏对左心功能及心室同步性的影响。方法:82例需安装永久起搏器并需心室起搏依赖的患者随机分为右室间隔起搏组(RVS组,40例)和右室心尖起搏组(RVA组,42例)。RVS组术后行胸CT检查并分析测量电极顶端的垂直距离和水平距离。两组均于术后1个月和9个月时行心脏超声检查,测量左室舒张末期内径(LVEDD)、左室射血分数(LVEF)及主动脉流速积分(AVTI),测量并计算室间机械延迟(IVMD)及左室各节段的达峰时间标准差(Ts-SD)。结果:经胸CT确定在后前位下,电极的理想位置为横向上三分之一和纵向三区之间的区域;术后1个月及9个月随访时,两组LVEDD、LVEF和AVTI相比无统计学差异,术后9个月两组IVMD及Ts-SD均差异有统计学意义(均P<0.05);QRS波时限与达峰时间差及Ts-SD呈正相关。结论:对心功能正常的起搏依赖患者,右室间隔起搏与心尖起搏短中期时左室功能未见明显不同,但右室间隔起搏有益于维持室间及室内收缩同步性。

Objective：To confirme ventricular lead position according to the chest CT and to compare the influ- ence of right ventricular septal pacing （RVSP） and right ventricular apex pacing （RVAP） on ventricular function and synehony. Method： A total of 82 patients with indications for permanent pacemakers was randomly divided in- to 2 groups： RVA group and RVS group. The RVS group did chest CT examination. The ventricle lead vertical distanc and the horizontal distance were measured. Two groups were undertook cardiac ultrasonography after 1 month and 9 months of implantation. The following parameters were obtained： left ventricular end-diastolic di- mension （LVEDD）, left ventricular ejection fraction （LVEF） and velocity time integral of aortic （AVTI）. The in- terventricular mechanical delay （IVMD） ,the time-to-peak systolic velocity （Ts） and calculating the standard devia- tion of the 12 LV segments （Ts-SD） were measured and calculated. Result： In the posteroanterior position of X ray, the perfect position of ventricle lead was between the horizontal 1/3 and one third longitudinal zones; The LVEDD, LVEF, AVTI were not statistically different in two groups during 1-month and 9-month follow up; The intraventricular and interventrieular synchron reached statistical significance at the end of follow up between the two groups; A positive and statistically significant correlation was found between the paced QRS duration and global dyssynchrony. Conclusion： The RVSP is superior to RVAP in terms of intraventricular synchrony and interventricular synchrony, but none in ventricular function 9 months after the implantation to the patients with normal heart function.