不同部位起搏对心脏收缩功能的影响

Effects of Different Pacing Modes on Left Ventricular Systolic Function

通过不同部位起搏 ,观察房室同步和心室激动顺序对人体心脏收缩功能的影响及起搏体表心电图QRS波时限与心输出量 (CO)的关系。 1 5例射频消融术后的病人分别按顺序进行右房、右室心尖部和室间隔起搏 ,采用心导管法分别测定右房压 (RAP)、肺动脉压 (PAP)、肺毛细血管楔压 (PCWP)和CO ,并计算心脏指数 ,记录心电图。结果 :右室心尖部起搏和室间隔起搏较右房起搏时RAP、PAP升高。心尖部起搏时CO较右房起搏降低 1 9.1 5 % (P <0 .0 1 ) ,室间隔起搏时CO较右房起搏降低 7.86% (P <0 .0 5 ) ,而较心尖部起搏提高 1 2 .2 4 % (P <0 .0 5 )。心尖部起搏和室间隔起搏较右房起搏体表心电图QRS波时限明显延长 ,而室间隔起搏体表心电图QRS波时限比心尖部起搏平均缩短 1 8.6ms(P <0 .0 0 1 )。CO和△QRS波时限的相关性分析表明两者呈负相关关系 (r=- 0 .30 ,P <0 .0 5 )。结论 :起搏体表心电图△QRS波时限与CO呈负相关 ,不同部位起搏对心脏收缩功能的影响不同 。

To observe the effects of atrio ventricular synchrony and ventricular activation sequence on human left ventricular systolic function, three pacing modes including right atrium pacing (RAP), right ventricular septal pacing (VSP) and right ventricular apex pacing (RVAP) were performed on 15 patients. The haemodynamics parameters including right atrium pressure (RAP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO), cardiac index (CI) and QRS duration were measured after each pacing mode was achieved stablely for five minutes. Results: Compared with RAP mode, VSP and RVAP increased PAP and RAP, but decreased CO and CI. During VSP mode, CO increased 12.24%( P <0.05)and QRS duration was shorten averagely about 18.6 ms( P <0.001)relative to RVAP mode. Conclusion: The atrio ventricular activation sequence and ventricular systolic synchrony can affect the left ventricular systolic function. Preserving the synchrony of ventricular systolic is more important in cardiac pacing. VSP is more fit for physiological pacing compared with RVAP.