长期置入不同类型起搏器对高龄缓慢性心律失常患者心脏功能的影响

Effects of long-term placement of different types of pacemakers on cardiac function in elderly patients with bradyarrhythmia

目的探讨长期置入单腔及双腔起搏器治疗高龄缓慢性心律失常(BA)患者的稳定性及对患者心功能的影响。方法回顾性分析2017年1月—2019年12月于我院进行置入永久性心脏起搏器治疗的76例高龄BA患者,根据患者置入心脏起搏器类型分为单腔起搏组(n=37)和双腔起搏组(n=39)。比较两组患者围术期并发症发生情况、起搏器参数(起搏阈值、导线阻抗、R波振幅)、心功能[左心室舒张末期容积(LVEDV)、左室射血分数(LVEF)、左心室收缩末期容积(LVESV)]以及心力衰竭住院情况等。结果两组患者围术期总并发症发生率差异无统计学意义(P>0.05);置入时及置入2年时两组患者起搏阈值、导线阻抗、R波振幅组内、组间比较差异均无统计学意义(P>0.05);置入2年时,单腔起搏组LVEF水平显著降低,LVESV水平显著升高(P<0.05),且相比于双腔起搏组,单腔起搏组LVEF水平显著降低,LVESV水平显著升高(P<0.05);单腔起搏组和双腔起搏组患者随访2年时心律衰竭住院率分别为8.11%(3/37)、5.13%(2/39),组间差异无统计学意义(P>0.05)。结论单腔及双腔起搏器长期置入治疗BA患者稳定性良好,但单腔起搏器可能损伤BA患者心功能,而双腔起搏器对患者心功能无明显不良影响。

Objective To analyze the effects of long-term placement of single-chamber and dual-chamber pacemakers on cardiac function in elderly patients with bradyarrhythmia(BA).Methods Patients with BA who underwent permanent pacemaker placement in the hospital from January 2017 to December 2019 were retrospectively analyzed.According to the type of pacemaker,the patients were divided into single-chamber pacemaker group(37 cases)and dual-chamber pacemaker group(39 cases).The perioperative complications,pacemaker parameters(pacing threshold,lead impedance,R wave amplitude),cardiac function[left ventricular end-diastolic volume(LVEDV),left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV)]and hospitalization due to heart failure were compared between the two groups.Results There was no significant difference in total incidence of perioperative complications between the two groups(P>0.05).At placement and 2 years after placement,there was no significant difference in pacing threshold,lead impedance or R wave amplitude between the two groups(P>0.05).At 2 years after placement,LVEF was significantly decreased(P<0.05),and LVESV was significantly increased in single-chamber pacemaker group(P<0.05).Compared with dual-chamber pacemaker group,LVEF was significantly decreased(P<0.05),and LVESV was significantly increased in single-chamber pacemaker group(P<0.05).The difference in incidence of hospitalization due to heart failure between single-chamber and dual-chamber pacemaker group was not statistically significant during 2-year follow-up[8.11%(3/37)vs 5.13%(2/39)](P>0.05).Conclusion Long-term placement of single-chamber and dual-chamber pacemakers has good stability in the treatment of BA patients.However,single-chamber pacemaker may damage cardiac function,while dual-chamber pacemaker has no significant adverse effects on cardiac function.