右心室中位间隔与右心室心尖部起搏对照研究

摘要

Objective To evaluate the feasibility and safety of right ventricle mid-septal pacing. Methods From November 2009 to June 2010, 42 patients who were suitable for permanent pacemaker implantation were randomly divided into right ventricle mid-septal pacing group ( RVSP group, n =21) or right ventricle apical pacing group ( RVAP group, n = 21). Patients were followed up for 3 months. X-ray exposure time, parameters of leads implantation, postoperative ECG, color Doppler, Minnesota Heart Failure quality of life score and 6-min walk test were compared between the two groups. Results Pacemaker was successfully implanted for all patients. Operation exposure time was similar between the two groups. ECG QRS duration in RVSP group was significantly shorter than that in RVAP group [ (90. 48 ±20. 61)ms and (127. 62 ± 16. 09 ) ms, P < 0. 01 ] . Stimulation threshold, electric current and impedance were significantly different between RVSP and RVAP group [(0.65 ±0.21)V vs. (0.50 ±0.16) V, (0.92 ±0.41) mA vs. (0.51 ±0.27) mA, ( 647. 77 ± 140. 34 ) Ω vs. ( 751. 09 ± 175. 64 )Ω, respectively, all P < 0. 05 ) ] . There was no statistically significant difference in Minnesota quality of life score and 6-min walk test score. Conclusion RVSP is feasible and safe. Compared with RVAP, RVSP can decrease X-ray exposure time and improve synchronization between right and left ventricle.%目的 评价右室中位间隔起搏方法的可行性和安全性.方法 纳入2009年11月至2010年6月需植入永久性心脏起搏器患者42例,随机分配入右心室间隔部起搏组(RVSP)21例,右心室心尖部起搏组(RVAP)21例.记录术中曝光时间、导线植人参数、心电图和术后心电图、彩色多普勒及术后3个月随访的一般资料、明尼苏达心力衰竭生活质量表评分及6分钟步行试验结果.结果 两组均顺利完成手术,手术曝光时间差异无统计学意义.RVSP组起搏后的QRS时限明显小于RVAP组[(90.48±20.61)ms比(127.62±16.09)ms],术中两组的感知幅值无差别,心室导线的起搏阈值、电流、阻抗[(0.65±0.21)V比(O.50±0.16)V,(0.92±0.41)mA比(0.51±0.27)mA,(647.77±140.34)Ω比(751.09±175.64)Ω]差异均有统计学意义(均为P＜O.05).在3个月的随访中两组心室起搏阈值的差异[(0.72±0.32)V比(O.63±O.21)V]有缩小的趋势(均为P＜O.05).术后组织多普勒成像技术(TDI)测量两组室间隔和左心室后壁之间的运动延迟(SPWMD)、心室间机械延迟时间(IVMD)、室间隔及左心室侧壁中段与基底段相比达峰时间、达峰速率及快速射血起始时间的差异均有统计学意义,而明尼苏达生活质量表评分及6分钟步行试验差异虽无统计学意义,但RVSP组仍优于RVAP组.随访中未出现起搏导线脱位或起搏、感知不良.结论 在X线指导下将室间隔分区,主动导线能精确、快捷地固定于右心室中位间隔部.与RVAP组相比,术中曝光时间相同,起搏后的体表QRS波明显变异,TDI测量左心室同步性好,且长期随访导线参数稳定,无脱位和起搏、感知不良.右心室中位间隔是较理想的起搏部位.