右室电极植入对心脏结构和功能的影响

Effect of right ventricular electrode implantation on cardiac structure and function

目的探讨右室电极植入对心脏结构和功能的影响。方法前瞻性入选2017年2月至2018年4月在阜外医院心律失常中心首次植入永久起搏器(PPM)/埋藏式心脏转复除颤器(ICD)治疗72例患者,结合二维+三维心脏超声检查方法,对心脏起搏器植入患者术前、术后1周以及术后1年进行超声评价,比较患者术前术后的超声数据的差异。结果入组72例患者均完成术后1年随访。术后1周复查心脏超声:新发三尖瓣返流(TR)2例,TR程度加重5例,术后1周导线相关三尖瓣返流(LRTR)的发生率为9.7%;术后1年,新发TR 2例,TR程度加重14例,术后1年LRTR的发生率为22.2%。与术前心脏结构和功能比较,电极导线植入术后1周,左右心脏结构和功能无明显变化;植入术后1年,三尖瓣返流(TR)程度为中重度返流的比例明显升高(16.7%vs 5.6%),伴右房、右室直径增大[右房直径:(37.66±5.52)mm vs(35.93±4.85)mm;右室直径:(24.49±3.87)mm vs(22.61±2.61)mm]以及右室射血分数降低[(0.46±0.06)vs(0.48±0.05),P均<0.05],而左心结构和功能无明显变化。与瓣叶非受限组患者比较,瓣叶受限组患者TR程度为中重度返流的比例明显升高(41.7%vs 12.1%),伴右房、右室直径增大[右房直径:(42.15±7.95)mm vs(36.76±4.47)mm;右室直径:(27.75±3.65)mm vs(23.84±3.60)mm]以及右室射血分数降低[(0.42±0.06)vs(0.47±0.06),P均<0.05]。结论心脏起搏治疗中LRTR的发生率较高;电极导线植入将加重TR程度,导致右房、右室增大以及右室射血分数降低;电极导线引起三尖瓣瓣叶受限与右心结构和功能的改变相关。

Objective To evaluate its impact on cardiac structure and function in patients with right ventricular electrode implantation.Methods Between February 2017to April 2018,a total of 72consecutive patients who were managed by the first implantation of permanent pacemaker(PPM)/implantable cardioverter defibrillator(ICD)at the arrhythmia center of Fuwai hospital were randomly enrolled in this prospective study.Initial evaluation was performed before device implantation and re-evaluation was performed after one weeks of the procedure,and one years respectively,by using two-dimensional and three-dimensional transthoracic echocardiography(TTE),we compared the differences of preoperative and postoperative echocardiographic data to evaluate its impact on cardiac structure and function.Results A total of 72patients were enrolled in this study,all patients completed one years follow-up.Qualified data from TTE at one weeks showed that 2patients of tricuspid regurgitation(TR)new-onset,5patients of TR worsen,and the incidence of lead-related TR(LRTR)was 9.7%.Qualified data from TTE at one years demonstrated that 2cases of TR new-onset,14cases of TR worsen,and the incidence of LRTR was 22.2%.Compared with preoperative cardiac structure and function,there was no significantly change in left and right cardiac structure and function during one weeks after device implantation.During one years follow up after device implantation,the proportion of TR with moderate to severe was significantly increased(16.7%vs 5.6%),with larger right atrial[(37.66±5.52)mm vs(35.93±4.85)mm]and right ventricular dimensions[(24.49±3.87)mm vs(22.61±2.61)mm],and lower right ventricular ejection fraction[(0.46±0.06)vs(0.48±0.05)](all P<0.05),but left-sided heart structure and function had no significantly changed.In comparison with patients with non-restricted group,the proportion of tricuspid reguritation(TR)with moderate to severe was significantly increased(41.7%vs 12.1%),combining with larger right atrial[(42.15±7.95)mm vs(36.76±4.47)mm]and right ventricular dimensions[(27.75±3.65)mm vs(23.84±3.60)mm],and lower right ventricular ejection fraction[(0.42±0.06)vs(0.47±0.06)]in patients with restricted group of tricuspid valve(all P<0.05).Conclusions The incidence of LRTR was higher in cardiac pacing therapy.Electrode lead implantation would aggravated TR severity,resulting in larger right2ᦈatrial and right ventricular dimensions,and lower right ventricular ejection fraction,in addition,the change of right-sided heart structure and function was associated with the restriction of tricuspid valve leaflet caused by the electrode lead.