比较右室流出道间隔部和中位室间隔部起搏参数及其对心功能的影响

Comparison of pacing parameters and influence on cardiac function between right ventricular outflow tract septum and median interventricular septum pacing

目的比较右室流出道间隔部(RVOTS)与中位室间隔部(MIVS)起搏参数及其对心功能的影响。方法将60例需植入起搏器的患者按起搏部位不同分为RVOTS起搏组和MIVS起搏组,每组各30例。比较两组患者术中和术后6个月起搏阈值、感知阈值、电极阻抗、起搏QRS波群宽度、术前和术后6个月左室舒张末期内径(LVEDD)、左室射血分数(LVEF)。结果术中和术后6个月两组患者起搏阈值、感知阈值和电极导线阻抗组间比较差异均无显著性;两组患者术后6个月各起搏参数与术中比较差异均无显著性。两组患者自主和起搏QRS波宽度组间比较差异均无显著性,两组患者起搏QRS波群均较自主QRS波群明显增宽,组内比较差异均具有显著性(P<0.05)。术前和术后6个月两组患者LVEDD和LVEF水平组间比较差异均无显著性;两组患者术后6个月LVEDD、LVEF水平与术前比较差异均无显著性。结论 RVOTS和MIVS起搏参数及其对心功能的影响相似,二者均可作为临床首选的右心室起搏部位。

Objective To compare the pacing parameters and the influence on cardiac function between right ventricular outflow tract septum（RVOTS） and median interventricular septum（MIVS） pacing. Method 60 patients implanted with cardiac pacemakers according to sites of right ventricular pacing were randomly divided into RVOTS group and MIVS group and each group with 30 cases. The pacing and sensing threshold, lead impedance and paced QRS duration during operation and 6 months after operation, the left ventricular end diastolic diameter（LVEDD） and left ventricular ejection fraction（LVEF） before operation and 6 months after operation were compared between the two groups. Result The pacing and sensing threshold and lead impedance during operation were no significant difference than 6 months after operation between the two groups. There was no diference in pacing and sensing threshold, lead impedance during operation, 6 months after operation in RVOTS group and MIVS group. There was no difference in independent QRS and paced QRS duration between the two groups. The paced QRS wave was wider than the independent QRS wave in the two groups（P〈0.05）. LVEDD and LVEF before operation were no significant difference than 6 months after operation between the two groups. There were no diference in LVEDD, LVEF between before operation, 6 months after operation in the two groups. Conclusion With the similar pacing parameters and influence on cardiac function, RVOTS and MIVS may all be the first choice of permanent right ventricular pacing site.