主动电极右室间隔部起搏的临床应用

Clinical application of active pacing leads in right ventricular septum pacing

目的观察主动电极行右室流出道间隔部起搏的疗效。方法以2008年5月至2013年5月在新乡市中心医院植入心脏起搏器的135例患者为研究对象,依据电极植入部位的不同分为四组:单腔起搏器(VVI)右室心尖部起搏组(52例,A组)、VVI右室间隔部起搏组(31例,B组)、双腔起搏器(DDD)右室心尖部起搏组(33例,C组)和DDD右室间隔部起搏组(19例,D组)。分析四组在术后即刻及术后1、6、12、24个月的起搏阈值、导线阻抗、QRS波时限和心功能相关指标。结果四组手术过程顺利,无并发症发生。B、D组术后即刻的起搏阈值较A、C组偏高,但差异无统计学意义(P>0.05)。四组的起搏感知及阻抗均无明显差异。随访1年后,A、B、C组患者的心功能指标较D组有所下降,差异均有统计学意义(P<0.05)。结论右室流出道间隔部起搏较右室心尖部起搏更符合生理性起搏的特点,对心功能及心室重构的不良影响明显小于右室心尖部起搏。因此,DDD右室间隔部起搏是一种较为理想的心脏起搏方式。

Objective To observe the effect of active pacing leads in right ventricular outflow tract（ RVOT） septum pacing. Methods We selected 135 patients as research objects who had been implanted with pacemakers in Xinxiang Central Hospital from May 2008 to May 2013. According to different sites of implanted pacing leads,they were divided into four groups： VVI right ventricular apex pacing group（52 cases,group A）,VVI right ventricular septum pacing group（31 cases,group B）,DDD right ventricular apex pacing group（ 33 cases,group C）,DDD right ventricular septum pacing group（ 19 cases,group D）. The pacing threshold,conductor impedance,QRS duration and heart function related indices immediately,1 month,6 months,12 months,and 24 months after pacemaker implantation were analyzed among the four groups. Results The implantation succeeded in the four groups without any complication. The pacing threshold of group B and D immediately after the operation was higher than that of group A and C,without statistically significant difference（P〉0. 05）. There showed no significant difference in pacing perception and impedance among the four groups. After a follow-up of 1 year,heart function indices of group D increased compared with those of the other three groups,and the differences were all statistically significant（P〈0. 05）. Conclusion RVOT septum pacing is more coincident with the characteristics of physiological pacing than right ventricular apex pacing,and its adverse effect on heart function and ventricular remodeling is weaker. Hence,DDD RVOT septum pacing is an ideal mode of cardiac pacing.