双腔起搏器最小心室化起搏与房室间期优化起搏对心功能影响的比较

Comparison of refined ventricular pacing and optimal AV delay pacing on the effect of heart function in patients with dual chamber pacemaker

目的观察双腔起搏器最小心室化起搏功能与最佳房室间期优化对减少心室起搏和心功能的影响。方法30例符合标准患者入选。随机分为最小心室化起搏组(RVP,n=16)和超声优化下最佳房室间期组(OAV,n=14)。首先,分别在术后1周和术后6个月进行随访,术后6个月两组交叉(RVP转OAV,OAV转RVP),并于术后1年再次随访。随访中评估右室起搏比例、6 min步行试验、纽约心功能分级、明尼苏达州心力衰竭患者生活质量问卷和左室射血分数等指标。结果术后6个月随访,RVP较OAV组的右室起搏比例明显降低(P<0.05)。至术后1年随访时,OAV转RVP组的右室起搏比例较RVP转OAV组明显降低(P<0.05)。交叉前后的自身比较显示起搏器RVP功能打开后能显著降低右室起搏比例(P<0.05)。其他各项指标在两组间都无显著差异(P>0.05)。结论两种优化方式对于患者短期心功能无明显影响,但RVP较OAV能明显减少右室起搏比例。

Objective To observe the effects of dual chamber pacemaker with right ventricular pacing function and optimal AV delay program on heart function and reduction in fight ventricular pacing proportion. Methods Thirty qualified patients were randomly divided into refined ventricular pacing group （RVP, n= 16） and optimal AV delaygroup （OAV, n = 14）. All patients were evaluated at 1 week, 6 months and 1 year after implantation. After followed up at 6 months of implantation, we used cross analysis between two groups （RVP-OAV, OAV-RVP）, and continued to follow up till 1 year of implantation. We evaluated right ventricular pacing proportion, 6 minutes walk test, cardiac function （ NYHA class）, minnesota living with heart failure questionnaire and left ventricular ejection fraction during follow-up. Results Right ventricular pacing proportion was significantly reduced in RVP group after 6 months of implantation and OAV-RVP group after 1 year of implantation. Self-matching test indicated that right ventricular pacing proportion was also significantly reduced af- ter RVP function was turned on in OAV-RVP group. There was no significant difference in other parameters. Conclusion RVP or OAV methods have no significant effects on short term heart function. But the right ventricular pacing proportion is significantly reduced when using RVP function. [ Chinese Journal of Cardiac Pacing and Electrophysiology,2015,29（6） ： 544-546 ]