右室不同部位起搏的急性血流动力学效应比较

Acute hemodynamic effect comparing of different pacing sites in right ventricle

关键词:  起搏  血流动力学  心脏超声

Key words:  pacing  hemodynamic  echocardiography

摘要:

[目的] 比较右室不同部位起搏的急性血流动力学效应，进一步明确最佳心室起搏部位。 [方法] 入选完全性房室传导阻滞患者47例。随机分为两组：A组（24例）植入临时起搏电极至右室心尖部组，B组（23例）植入临时起搏电极至右室流出道，其后两组患者均植入永久起搏电极至右室高位间隔部。比较不同部位起搏下的每搏量（SV）、左室舒张末期直径（LV）、左室射血分数（LVEF）、左房内径（LA）以及QRS波时限的差异。 [结果] 右室流出道与心尖部起搏比较，LVEF和SV值略有改善P=0.071, P=0.043, LVD和LAD，以及QRS波时限变化不大。高位间隔和右室心尖部起搏比较，LVEF值、SV 以及QRS波时限明显改善，P值分别为0.007 和0.002以及P<0.001；LVD和 LAD无变化。高位间隔和右室流出道起搏比较，LVEF值和SV以及QRS波时限有所改善，P值分别为0.017和0.014，以及P<0.001；LVD和LAD无变化。[结论] 高位间隔起搏明显优于流出道和心尖部起搏。而流出道起搏略优于心尖部起搏。

Abstract:

[Ojective] This study was aimed to compare the acute hemodynamic effects of different pacing sites in right ventricle (RV). [Methods] 47 cases of total atrioventricular conduction block patients were enrolled and divided into 2 groups. Patients of group A (24 cases) were placed temporal pacemaker leads at apex of right ventricle (RVA). Patients of group B (23 cases) were placed temporal pacemaker leads at outflow tract of right ventricle (RVF). All patients were followed implanted permanent pacemaker with leads at high septum of right ventricle (RVS). Echocardiography parameters and QRS complex duration were measured and compared at different pacing sites. [Results] Compared between RVF and RVA pacing sites, the LVEFs and SVs were improved (P=0.071 and P=0.043)；LVDs, LADs, and the duration of QRS waves were no difference. Compared between RVS and RVA pacing sites, the LVEFs, SVs, and the duration of QRS waves were improved significantly(P=0.007, P=0.002, P<0.001); LVDs and LADs were no difference. Compared between RVF and RVS pacing sites, the LVEFs,SVs, and the duration of QRS waves were improved significantly (P=0.017, P=0.014, P<0.001); LVDs and LADs were no difference. [Conclusions] RVS pacing were superior to RVF and RVA pacing significantly. RVF pacing was better than RVA pacing.