实时三维超声心动图评价右心室不同部位起搏对左心房收缩功能的影响

Real-time Three-dimensional Echocardiography in Evaluating Left Atrial Systolic Function in Patients with Different Pacing Site of Right Ventricle

目的运用实时三维超声心动图评价房室顺序型心脏起搏器的右心室间隔部(RVS)起搏及心尖部(RVA)起搏对房室传导阻滞患者左心房收缩功能的影响。资料与方法 51例具备埋藏式心脏起搏器植入适应证的房室传导阻滞患者采用掷硬币法随机分为RVS组31例和RVA组20例,应用实时三维超声心动图测定患者植入房室顺序型心脏起搏器术前、术后1个月、3个月、6个月及12个月的左心房最小容积(LAVmin)、左心房最大容积(LAVmax)、左心房收缩前容积(LAVprep)、左心房总射血分数(LATEF)及左心房主动射血分数(LAAEF)。结果两组LAVmin于术后3个月开始较术前和术后1个月降低(RVA组:t=2.97、2.74,P<0.05;RVS组:t=3.24、2.86,P<0.05);RVA组自术后6个月开始、RVS组自术后3个月开始,LAVprep均较术前缩小(RVA组:t=3.20,P<0.05;RVS组:t=2.71,P<0.05);两组LATEF和LAAEF均于术后3个月开始较术前提高(RVA组:t=2.87、9.68,P<0.05;RVS组:t=3.56、8.22,P<0.05);RVS组术后6个月、12个月的LATEF和LAAEF均大于同时间点的RVA组(t=2.90、5.22、3.03、3.55,P<0.05)。结论房室顺序起搏有利于房室传导阻滞患者左心房收缩功能的恢复,RVS起搏较RVA起搏可以更大幅度地提升患者左心房射血分数。

Purpose To evaluate the effect of right ventricular septum（RVS） and right ventricular apex（RVA） pacing on the left atrial systolic function in patients with atrioventricular block by using real-time three-dimensional echocardiography（RT-3DE）. Materials and Methods Fifty-one patients with atrioventricular block who were candidates for implanted atrioventricular sequential pacemaker were randomly divided into RVS group（n=31） and RVA group（n=20）. The minimum left atrium volume（LAVmin）, maximum left atrium volume（LAVmax）, and left atrium volume before contraction（LAVprep） were measured by RT-3DE at pre-operation, the 1st month, 3rd month, 6th month, and 12 th month after pacemaker implantation. Accordingly, the left atrial total ejection fraction（LATEF） and the left atrial active ejection fraction（LAAEF） were calculated. Results The LAVmin at the 3rd month, 6th month, 12 th month after implantation were significantly lower than that at the 1st month and pre-operation in both groups（RVA group： t=2.97 and 2.74, P〈0.05; RVS group： t=3.24 and 2.86, P〈0.05）. LAVprep at the 6th month, 12 th month in RVA group, and LAVprep at the 3rd month, 6th month, 12 th month in RVS group reduced when compared with that of pre-operation（RVA group： t=3.20, P〈0.05; RVS group： t=2.71, P〈0.05）. LATEF and LAAEF in both groups at the 3rd month, 6th month, 12 th month increased when compared with that of pre-operation（RVA group： t=2.87 and 9.68, P〈0.05; RVS group： t=3.56 and 8.22, P〈0.05）. The LATEF and LAAEF in RVS group at the 6th month and 12 th month after implantation were significantly larger than that in RVA group at the same time（t=2.90, 5.22, 3.03 and 3.55, P〈0.05）. Conclusion Atrioventricular sequential pacing is helpful to recovering the left atrial systolic function in patients with atrioventricular block. Compared with RVA pacing, RVS pacing is able to increase LATEF and LAAEF more greatly.