右室起搏部位与比例对心室事件及心功能影响

摘要

Objective To observe the influences of right ventreular septum ( RVS ) pacing and right ventricular apex (RVA) pacing with different pacing proportion on ventricular events and heart function. Methods The patient ( n=96) with double cavity pacemaker operation for one year were selected and divided into RVS group (n=48 ) and RVA group (n=48 ) according to different pacing positions. These two groups were divided respectively, according to the proportion of ventricular pacing ( VP) , into VP≤ 10% group ( n=16 ) , VP1 1%-89%' group (n=16) and VP≥90% group (n=16 ) by applying program-controlled auto AV searching combining the auto-reaction of the patients. The cardiac color ultrasound was used to record left ventricular end diastolic diameter ( LVEDD ) and left ventricular ejection fraction ( LVEF ) , and pacemaker programming instrument was used to ask ventricular high-frequency events ( VHR ) and premature ventricular contractions ( PVC ) . Results Compared with RVS group, single PVC increased in RVA group, while there was no difference in the incidence of VHR between two groups. As the increase of proportion of right ventricular pacing, VHR and PVC decreased, and LVEF decrased and LVEDD increased in RVA group. Conclusion RVS pacing can reduce PVC, delay heart function fails and decrease pacing proportion. The incidence of PCV is increased although heart function fails are delayed.%目的 观察不同起搏比例的右室间隔部(RVS)和心尖部(RVA)起搏对心室事件和心功能影响.方法 纳入置入双腔起搏器术满1年的患者96例,按照起搏部位不同分为RVS起搏组(n=48)和RVA起搏组(n=48),利用程控房室间期自动搜索功能的打开与关闭,结合患者自身反应,按照心室起搏(VP)比例分为VP≤10%组(16例)、VP11%～89%组(16例)、VP≥90%组(16例).通过心脏彩超记录左室舒张末期内径(LVEDD)、左室射血分数(LVEF);由起搏器程控仪询问心室高频事件(VHR)和室性早搏(PVC).结果 RVA起搏比RVS起搏PVC增多,VHR发生率无差异;随VP比例增加,两组VHR和PVC减少,RVA起搏组LVEF下降、LVEDD增大.结论 RVS起搏较RVA起搏可减少PVC、延缓心功能减退;降低VP虽可延缓新功能减退但会造成PVC增加.