右室流出道间隔部起搏与右室心尖部起搏对原有心功能不全患者影响的比较

Effects of Right Ventricular Outflow Tract Pacing and Right Ventricular Apex Pacing on Patients with Cardiac Dysfunction

目的探讨右心室心尖部（right ventricularapex，RVA）起搏和右心室流出道（right ventfieular outflow trace，RVOT）间隔部起搏对缓慢型心律失常伴有心功能不全的患者心脏收缩功能的影响。方法①将80例符合缓慢型心律失常需要安装心脏永久起搏器并且原有心功能不全的患者随机分为RVA起搏和RVOT间隔部起搏两组；②分析和比较术后即刻和术后3个月两组右心室电极导线心室起搏比率、电极阻抗、起搏阈值；③分析和比较两组术前和术后3个月心电图标准Ⅱ导联QRS宽度；④比较两组术前和术后3个月超声心动图左室射血分数（LVEF％）、Tei指数、心排指数（cI）、二尖瓣血流频谱E／A比值、左室压力最大上升速率（dp／dtmax），观察患者心功能的变化。结果①与RVOT间隔部起搏组相比，RVA组心电图标准Ⅱ导联QRS波更宽（173．80±5．42vs118．35±3．05），差异具有统计学意义；②术前2组LVEF、Tei、CI、E／A和dp／dtmax差异均无统计学意义；与术前相比，RVA起搏组LVEF、Tei、CI、E／A和dp／dtmax均有下降，差异具有统计学意义（60．25±5．34vs54．10±4．53；0．46±0．04vs0．49±0．04；2．86±0．54vs2．48±0．43；1．72±0．60vs1．24±0．43；1701．93±53．46vs1800．55±58．00）。与术前相比，RVOT组差异无统计学意义（60．27±4．39vs59．10±4．35；0．45±0．03vs0．44±0．05；2．88±0．39vs2．79±0．42；1．73±0．49vs1．71±0．49；1697．33±62．99vs1706．45±63．07）。结论对于原有心功能不全且需要安装心脏永久起搏器的患者，与RVA起搏相比，RVOT间隔部起搏更接近生理性左心室与右心室电一机械收缩活动，能避免心功能的进一步恶化，是一种较理想的起搏部位。

Objective To explore the effects of right ventricular outflow tract（RVOT） pacing and right ventricu- lar apex（RVA） pacing on cardiac function in patients with bradyarrhythmia combined with cardiac dysfunction. Meth- ods ①80 patients with bradyarrhythmia and cardiac dysfunction were randomly divided into RVOT pacing group and RVA pacing group. ②Ventricular pacing rates, electrode impedance and pacing threshold were analyzed and com- pared immediately after operation and 3 months after operation between the two groups. ③Electrocardiogram QRS lead II width was analyzed and compared immediately after operation and 3 months after operation between the two groups. ④Left ventricular ejection fraction （LVEF）, Tei index, cardiac output index（CI）, E/A ratio of mitral valve flow pattern and maximum left ventricular pressure rise rate（dp/dtmax） were analyzed and compared immediately after op- eration and 3 months after operation in order to observe changes of cardiac function between the two groups. Results ①QRS（ 173.80 ± 5.42） in RVA group was significantly wider than that in RVOT group（ 118.35 ± 3.05 ） ;②There were no significances in LVEF,Tei, CI, E/A and dp/dtmax between the two group before operate. LVEF, Tei, CI, E/A and dp/dtmax were lower after operation than those before operation in RVA pacing group（ 60.25 ± 5.34 vs 54.10 ± 4.53; 0.46 ±0.04 vs 0.49 ±0.04;2.86 ±0.54 vs 2.48 ±0.43;1.72 ±0.60 vs 1.24 ±0.43;1701.93 ±53.46 vs 1800.55 ± 58.00）. There were no significant differences in LVEF, Tei, CI, E/A and dp/dtmax before and after opera- tion in RVOT group. Conclusion RVOT pacing is closer to electrical - mechanical contractile activity of left ventricle and right ventricle for patients with cardiac dysfunction than RVA pacing, which can avoid cardiac deterioration .