低位房间隔起搏对病态窦房结综合征患者心房同步性和功能的影响

The influence of low atrial septal pacing on atrial synchrony and function in patients with sick sinus syndrome

目的旨在评价低位房间隔起搏对病态窦房结综合征(SSS)患者心房电学、机械同步性和功能的影响。方法本研究为随机对照研究,入选自2015年6月至2016年9月入住中国科学技术大学附属第一医院,具有永久起搏适应证的SSS患者100例,根据P波时限分为房间传导阻滞组(P>120ms)和无房间传导阻滞组(P≤120ms),通过随机分组软件分为无房间传导阻滞右心耳起搏组(A组)、无房间传导阻滞低位房间隔起搏组(B组)、房间传导阻滞右心耳起搏组(C组)和房间传导阻滞低位房间隔起搏组(D组)。通过心电图和超声心动图评价不同部位起搏对心房电学、机械同步性和功能的影响,包括P波时限、P波离散度、左心房16节段从心电图QRS时限起点到左心房收缩最小容积时间的标准差(Tmsv-16-SD)、RR间期校正的Tmsv-16-SD(Tmsv-16-SD%)和左心房射血分数(LAEF)等指标。结果低位房间隔起搏可改善合并房间传导阻滞患者的P波时限[(130.4±8.3)ms对(118.2±7.8)ms,P<0.01]、P波离散度[(29.8±7.4)ms对(26.2±5.1)ms,P<0.01]和左心房Tmsv-16-SD[(134.2±35.1)ms对(110.9±21.7)ms,P<0.01]、Tmsv-16-SD%[(17.4%±4.3%)对(14.3%±2.7%),P<0.01],改善LAEF[(41.6%±6.6%)对(44.7%±7.5%),P<0.01]、纵向应变(mSs)[(39.9%±9.1%)对(41.2%±8.5%),P<0.01]、收缩期纵向应变率(mSRs)[(3.6±0.7)s^-1对(3.9±0.7)s^-1,P<0.01]和舒张晚期纵向应变率(mSRa)[(-2.8±0.4)s^-1对(-3.1±0.5)s^-1,P<0.01];右心耳起搏增加了SSS患者P波时限、P波离散度和Tmsv-16-SD、Tmsv-16-SD%(P<0.05),降低合并房间传导阻滞SSS患者的LAEF、mSs、mSRs、mSRe和mSRa(均P<0.01);心房P波时限、P波离散度和Tmsv-16-SD、Tmsv-16-SD%高度相关(均P<0.01)。结论低位房间隔起搏可改善合并房间传导阻滞SSS患者的心房电学和机械同步性,改善心房功能。

Objective To assess the influence of low atrial septal pacing on atrial electrical,mechanical synchrony and function in patients with sick sinus syndrome(SSS).Methods One hundred patients with sick sinus syndrome and permanent pacing indication were enrolled from June 2015 to September 2016 at the First Affiliated Hospital of University of Science and Technology of China,and divided into non-interatrial block group(P≤120 ms)and interatrial block group(P>120 ms)according to the duration of P wave,then randomly divided into non-interatrial block with right atrial appendage pacing group(A),non-interatrial block with low atrial septal pacing group(B),interatrial block with right atrial appendage pacing group(C),and interatrial block with low atrial septal pacing group(D).The electrocardiogram and echocardiography were used to evaluate the influence of selective atrial pacing on atrial electrical,mechanical synchrony and function.Results The P wave duration[(130.4±8.3)ms vs.(118.2±7.8)ms,P<0.01],and dispersion[(29.8±7.4)ms vs.(26.2±5.1)ms,P<0.01)],Tmsv-16-SD[(134.2±35.1)ms vs.(110.9±21.7)ms,P<0.01]Tmsv-16-SD%[(17.4±4.3)%vs.(14.3±2.7)%,P<0.01],left atrial ejection fraction(LAEF)[(41.6%±6.6%)vs.(44.7%±7.5%),P<0.01],strain(mSs)[(39.9%±9.1%)vs.(41.2%±8.5%),P<0.01],strain rate(mSRs)[(3.6±0.7)s^-1 vs.(3.9±0.7)s^-1,P<0.01]and strain rate(mSRa)[(-2.8±0.4)s^-1 vs.(-3.1±0.5)s^-1,P<0.01]were improved by low atrial septal pacing in patients with interatrial block and SSS.The P wave durationand dispersion,Tmsv-16-SD and Tmsv-16-SD%were increased by right atrial appendage pacing in SSS patients(P<0.05),LAEF,mSs,mSRs,mSRe and mSRa were decreased by right atrial appendage pacing in patients with interatrial block and SSS(all P<0.01).The P wave duration,dispersion and Tmsv-16-SD,Tmsv-16-SD%were highly correlated(all P<0.01).Conclusion In patients with SSS and interatrial block,low atrial septal pacing could improve the atrial electrical,mechanical synchrony and function.