病态窦房结综合征患者DDD起搏器植入术后房室顺序下传及右室心尖部起搏模式下左心室舒张功能评估

Study of left ventricular diastolic function in patients with DDD pacemaker implantation for sick sinus syndrome during atrioventricular conduction and right ventricular apex pacing mode

目的分析因病态窦房结综合征（sicksinussyndrome，SSS）行DDD起搏器植入患者在房室顺序下传（atrioventricularconduction，AVc）及右室心尖部起搏（rightventricularapexpacing，RVAP）模式下的左心室舒张功能参数，探讨DDD起搏器植入患者不同传导或起搏模式对左室舒张功能的影响。方法选择植入DDD起搏器的SSS患者46例，将起搏模式程控于AVC和RVAP模式，选取50例志愿者设为对照组。分别测量两种模式下及对照组二尖瓣口舒张期血流频谱参数、二尖瓣环舒张期运动速度参数、左心房容积指数、左心室解旋速度，并对舒张功能分级进行定性评估。结果与对照组比较，AVC及RVAP模式下，二尖瓣口血流PW、二尖瓣环TDIPW参数中，E峰减速时间延长，E峰斜率降低，二尖瓣环间隔侧舒张早期运动速度降低；左心室、心底及心尖解旋速度峰值降低；舒张功能分级在各组的构成比呈现显著差异，主要表现为起搏模式下，舒张功能异常的级别升高。结论DDD起搏器植入的SSS患者在AVC及RVAP模式下，均可出现或加重左室舒张功能的异常，以RVAP模式更为明显。

Objective To analyze the left ventricular （LV） diastolic function parameters of patients with sick sinus syndrome （SSS） and DDD pacemaker implantation during atrioventricular conduction （AVC） and right ventricular apex pacing （RVAP） mode. Methods Forty-six consecutive patients with SSS who had undergone DDD pacemaker implantation were studied. Fifty volunteers were selected as control group. Changing from AVC to RVAP mode, the acute effect on echocardiographic left ventricular diastolic function parameters, including mitral inflow PW parameters, mitral annulus tissue Doppler imaging parameters, left atrial volume index, and LV/apical/basal untwist parameters were measured. And all subjects were classified into normal diastolic function or three degrees of LV diastolic dysfunction. Results Compared with control group, both AVC and RVAP mode of patients with DDD pacemaker implantation resulted in the worsening of LV diastolic function as shown by （1） prolonged deceleration time of E wave, decreased descending slope of E wave, as well as decreased early diastolic velocity at the septal mitral annulus, （2） the decrease of LV/basal/apical untwist velocity, （3） the increase in the degree of diastolic dysfunction. Conclusions In patients with DDD pacemaker implantation, both AVC and RVAP mode are associated with the deterioration of LV diastolic function, which is particularly obvious in RVAP mode.