右室中位间隔起搏治疗缓慢型心律失常的临床效果观察

Clinical Effect of Right Ventricular Mid-septal Pacing in Patients with Bradyarrhythmia

目的:评价应用主动固定电极行右室中位间隔起搏治疗缓慢型心律失常的可行性、有效性与安全性。方法:选择2014年9月-2015年9月在本院心血管内科行永久性起搏器植入术的缓慢型心律失常患者40例,随机分成两组,每组各20例,分别行右室中位间隔起搏(RVSP组)和右室心尖部起搏组(RVAP组)。并对比两组心室电极植入时间、术中透视时间,心室起搏心电图QRS波群宽度,术毕与术后3个月电极阈值、感知、阻抗,术前与术后3个月左室射血分数(LVEF)、室间隔与左室后壁运动延迟时间(SPWMD)等指标,并记录术中、术后相关不良反应。结果:与RVAP组相比,RVSP组电极植入时间与透视时间比较差异无统计学意义(P>0.05)。两组术毕及术后3个月阈值、感知、阻抗,以及术前与术后3个月LVEF比较差异均无统计学意义(P>0.05)。与RVAP组相比,RVSP组心室起搏心电图QRS波形较窄,SPWMD更少,两组比较差异均有统计学意义(P<0.01)。本试验中未发现围术期相关的不良反应。结论:主动固定电极右室中位间隔起搏安全有效,适宜县区级医院临床推广应用。

Objective：To evaluate the feasibility, availability, and safety of right ventricular mid-septal pacing（RVSP） technique by using active fixation lead in patients with bradyarrhythmia.Method： Forty patients diagnosed with bradyarrhythmia were selected in our hospital,from September 2014 to September 2015.Patients were randomly assigned to RVSP group and RVAP group,20 cases in each group.The ventricular electrode implantation time,intra-operative radiation time,and the width of QRS wave of ventricular pacing ECG of two groups were recorded.Immediately and 3 monthes after the surgery,the threshold,perception and impedance of ventricular electrode of two groups were compared;before and 3 monthes after the surgery,left ventricular ejection fraction（LVEF） and septal-to-posterior wall motion delay（SPWMD） of two groups were compared.Besides,theperi-operative adverse events of two groups were observed.Result：There was no significant difference in the time of ventricular electrode implantation and intra-operative radiation（P〈0.05）.Compared the threshold,perception,and impedance of ventricular electrode of two groups in immediately and 3 monthes after the surgery,as well as the LVEF before and 3 monthes after the surgery,the differences were no statistically significant（P〉0.05）.More narrow of the width QRS wave of ventricular pacing ECG and less SPWMD in RVSP group than RVAP group, the difference were statistically significant（P〈0.05）.There were no adverse events in two groups during peri-operation.Conclusion：RVSP by using active fixation lead is the safe and effective technique in patients with bradyarrhythmia.