右室中位间隔部起搏与右室高位间隔部起搏对心功能的影响

The influence of median and high right ventricular septum pacing on cardiac function

目的探讨右室中位间隔部起搏与右室高位间隔部起搏因起搏部位不同是否对心功能产生不同影响。方法选择2008年1月至2013年8月在我院因高度房室阻滞行双腔起搏器置入术的患者,共148例。随机分为高位室间隔组及中位室间隔组,随访术后18个月超声心动图,监测左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室Tei指数,并测定NTpro-BNP浓度。结果术后18个月中位室间隔组与高位室间隔组比较,LVEF明显提高,LVEDD则明显缩小;中位室间隔组NTpro-BNP和Tei指数明显低于高位室间隔组,差异有统计学意义(P<0.05)。其中,中位室间隔组术后与术前比较,LVEF有降低趋势,LVEDD有增大趋势,差异无统计学意义(P>0.05);高位室间隔组术后与术前比较,同样LVEF有降低趋势,LVEDD有增大趋势,差异有统计学意义(P<0.05)。结论右室间隔部中位起搏较右室间隔部高位起搏可明显减少对心功能的影响。

Objective To discuss whether different pacing sites of median and high right ven- tricular septum have different influence on cardiac function. Methods A total of 148 patients were selected who had undergone double-chamber pacemaker implantation for high degree atrioventrieular block from January 2008 to August 2013 in our hospital. They were randomly divided into high ven- tricular septal group and median ventricular septal group. Eighteen months after the operation, their echocardiogram, and several indices such as left ventricular ejection fraction（LVEF） , left ventricu- lar end-diastolic diameter（LVEDD） and left ventricular Tei index were observed. In addition, the NTpro-BNP thickness was measured. Results Eighteen months after the operation, LVEF of medi- an ventricular septal group was significantly higher while LVEDD was significantly smaller, if com- pared with those of high ventricular septal group. NTpro-BNP and Tei index of median ventricular septal group were significantly lower than those of high ventricular septal group, with statistically sig- nificant differences （P 〈 0.05）. In median ventricular septal group, post-operation LVEF decreased while LVEDD increased, if compared with pre-operation indices, without statistically significant differences （ P 〉 0.05 ）. LVEF and LVEDD in high ventricular septal group changed in the same way as the above, however, with statistically significant differences （P 〈 0.05 ）. Conclusion The im- pact of median right ventricular septum pacing on cardiac function can be significantly weakened, if compared with that of high right ventricular septum pacing.