右室流出道间隔部起搏对心功能影响的临床研究

Clinical application of right outflow tract septal pacing of active electrode lead

目的 比较右室流出道间隔部起搏和右室心尖部起搏的植入技术参数和心电图的变化，以及间隔部起搏1年后对心功能的影响。方法 入选符合起搏器植入指征患者80例，30例行右室心尖部被动电极植入（被动电极组），50例行右室流出道间隔部主动螺旋电极植入（主动电极组），两组在植入时间、曝光时间、心电图的变化进行分析对比，及间隔部起搏1年后行心脏彩超检查观察对心功能的影响变化。结果 主动电极组较被动电极组植入时间及曝光时间长[（20.00 ± 3.48）min比（15.00 ± 2.67）min、（9.45 ± 3.48）min比（6.78 ± 2.67）min]，差异有统计学意义（P〈0.05），而主动电极组QRS时限及QTc时限较被动电极组短[（0.119 2 ± 0.042 1）s比（0.142 3 ± 0.032 4）s、（0.403 5 ± 0.026 8）s比（0.442 7 ± 0.054 1）s]，差异有统计学意义（P〈0.05），随访1年后主动电极组，左房舒张末期内径、左室舒张末期内径及左室射血分数较术前未发生明显变化。结论 右室流出道间隔部主动螺旋电极间隔部起搏较被动电极心尖部起搏更加符合生理性起搏，是较为理想的起搏部位。

Objective To investigate the advantage and disadvantage of the right ventricular outflow septal pacing.Methods Eighty patients requiring pacemaker because of slow arrhythmia were randomly divided into the active fixation group and passive fixation group. The implantation time, radiation exposure time and changes of electrocardiogram were compared between 2 groups, and the heart function changes 1 year after treatment were observed by color Doppler ultrasound.Results The implantation time and radiation exposure time in active fixation group were significantly longer than those in passive fixation group： （20.00 ± 3.48） min vs. （15.00 ± 2.67） min and （9.45 ± 3.48） min vs. （6.78 ± 2.67） min, and there were statistical differences （P〈0.05）. The QRS duration and QTc duration in active fixation group were significantly shorter than those in passive fixation group： （0.119 2 ± 0.042 1） s vs. （0.142 3 ± 0.032 4） s and （0.403 5 ± 0.026 8） s vs. （0.442 7 ± 0.054 1） s, and there were statistical differences （P〈0.05）. In active fixation group, there were no statistical differences in left atrial diameter, left ventricular end-diastolic diameter, left ventricular minor axis decurtaion rate and left ventricular ejection fraction, compared before treatment and 1 year after treatment （P〉0.05）.Conclusions The application of the active electrode lead in the right outflow trace septal pacing is more associated with wider physiological ventricular function.