不同起搏方式对心脏结构的影响

Impact on cardiac structure in different pacing mode

目的 评价不同起搏方式 (DDD方式和 VVI方式 )对长期心脏起搏患者左心结构的影响。方法 选择安装永久起搏器患者 6 3例 ,其中 VVI起搏 38例 ,DDD起搏 2 5例 ,运用超声心动图仪观测起搏器置入前及置入后随访期左心结构及功能的变化。结果 VVI起搏平均 (31.6± 5 .8)月时左心房内径扩大 ,从 (32 .6 8± 4 .71) mm至 (38.31±5 .2 1) m m ;左心室舒张末期内径扩大 ,从 (4 8.2 4± 4 .93) mm至 (5 1.33± 5 .6 4 ) mm ;室间隔厚度增加 ,从 (8.91±1.12 ) mm至 (10 .32± 1.4 3) mm ;左心室重量指数增加 ,从 (96 .75± 13.32 ) g/m2 至 (12 9.1± 2 1.79) g/m2 ;左心室射血分数下降 ,从 0 .5 1± 0 .0 79至 0 .4 7± 0 .0 71,与术前比较有显著差异 (P<0 .0 5 )。 DDD起搏平均 (30 .2± 6 .3)月时 ,左心结构及左心室射血分数变化不明显 (P>0 .0 5 )。结论 DDD起搏对左心结构影响较小 。

Objective To assess the impact on cardiac structure of different pacing mode in patients with permanent Pacemaker. Methods 63 patients including 38VVI and 25DDD were detected by echocardiography left heart structure and function before and after implantation. Results For VVI patients, at the 31.6±5.8months of follow-up ,changes happened: dilation of left atrial(from 32.68±4.71 to 38.31±5.21 mm), increasing of left ventricular diameter(from 48.24±4.93 to 51.33±5.64 mm) and hypertrophy of interventricular septum(from 8.91±1.12 to 10.32±1.43 mm) accompanied with the increasing of left ventricular wight indices(from 96.75±13.32 to 129.1±21.79 g/m 2) which were significantly different from pre-implantation(P<0.05). The left ventricular ejection fraction(LVEF) decreased(from 0.51±0.079 to 0.47±0.071) significantly in VVI group(P<0.05). However, DDD pacing had little impact on the patients left ventricular structure and the LVEF at the 30.2±6.3 months follow-up(P>0.05). Conclusion DDD pacing had little affect on left heart but VVI pacing had result in remodeling of left heart.