右室流出道间隔部起搏的临床观察

A clinical study of pacing in riht ventricular outflow tract

目的：通过对永久起搏器植入术后患者的长期临床随访观察比较右室流出道（ RVOT）间隔部起搏及右室心尖部（ RVA）起搏对左右心室同步性、心功能的影响。方法30例因高度房室传导阻滞需要安置心脏永久起搏器的患者，按照数字表法随机分为RVA组和RVOT组，各15例，置入DDD或VVI型起搏器。术后分别于3、12个月程控起搏器，行多普勒超声观察左右室同步时间、左室舒张末径（ LVDd）、左室射血分数（EF），心电图QRS波宽度（QRSd）、6 min步行距离（6MWT）检查。结果随访12个月未见电极移位、脱位及其它并发症。 RVOT组间隔部起搏左右心室同步性[（59±10）ms]明显好于RVA组[（80±11）ms]（P＜0．05）。术后随访RVOT 组 EF[（60±4）％]、LVDd[（45±6） mm]、6MWT[440±10） m]，均优于 RVA 组[（48±5）％、（54±7）mm、（380±13）m]（均P＜0．05），RVOT组的QRSd[（134±9）ms]较RVA组的[（186±20）ms]有明显的缩短（P＜0．05）。结论 RVOT间隔部起搏较RVA起搏更有助于维持心室的正常激动及同步性，应提倡RVOT间隔部起搏。

Objective To compare the effects on cardiac function between pacings of right outflow tract （ RV-OT） and right vcntricular apex （ RVA） .Methods According to the digital table ,30 patients with high degree atrio-ventricular block which need for permanent pacemaker were randomly divided into the group RVA and group RVOT , 15 cases in each group ,and the DDD or VVI pacemaker was implanted .The programmable pacemakers was carried out,3,12 months after the operation.By Doppler ultrasound,the left and right ventricular synchronization time ,end diastolic diameter （ LVDd） ,left ventricular ejection fraction （ EF） was checked ,ECG QRS wave width （ QRSd） ,6 mi-nutes walking distance （6MWT） was examined.Results Followed up for 12 months,there was no shift,electrode dislocation and other complications .The left and right ventricular synchronization time of group RVOT [（59 ±10）ms] was significantly better that that in the RVA group [（80 ±11）ms]（P〈0.05）.Following up,the EF[（60 ±4）%], LVDd[（45 ±6）mm],6MWT[440 ±10）m]in RVOT group after operation were better than [（48 ±5）%,（54 ±7） mm,（380 ±13）m]（all P〈0.05）,the QRSd of RVOT group[（134 ±9）ms]was significantly shortened than that of group RVA[（186 ±20）ms]（P〈0.05）.Conclusion RVOT septum pacing can be more effective in cardiac func-tion than RVA pacing .