Objective To compare the effect of right ventricular outflow tract (RVOT) and right ventricular apex (RVA) pacing on ventricular systolic synchrony using gated blood pool SPECT (GBPS).Methods A total of 50 patients implanted with pacemaker due to high degree or complete atria-ventricular block were enrolled in the study. Twenty-three patients were RVOT paced ( Group A, n = 23) and 27 were RVA paced (Group B, n=27). Twenty-four patients with malignancy, normal echocardiographic findings and no history of cardiac diseases were scheduled for pre-chemotherapy evaluation of cardiac structure and function and were enrolled as control group ( Group C, n = 24). All patients underwent GBPS imaging and the values of phase angle (PS), mean phase of each wall, standard deviation (SD) of mean phase of each wall, lateral-septal motion delay of left ventricle ( LV Sep-Lat Delay), septal-right ventricular (RV) delay of LV ( LV Sep-RV Delay) and LV-RV Delay were acquired. The parameters of ventricular systolic synchrony among the three groups were compared using one-way ANOVA. Results The mean phase of LV lateral wall in Groups A and B were significantly higher than that in Group C: Group A (120.50 ±40.58) ms; Group B (103.23±28.34) ms; Group C (84.63 ±22.38) ms (F=7.72, P ＜0.05). There was no significant difference between Groups A and B ( t = 1.30, P ＞ 0.05 ). The mean phase of RV in Group A was significantly larger than those in Groups B and C: Group A ( 137.05 ± 39.27) ms, Group B ( 100.85 ± 23.79) ms,Group C (59. 13 ±30.52) ms (F=35.55, P＜0.05). PS, SD and LV Sep-Lat Delay in Groups A and B were significantly higher than those in Group C: (85.73 ± 12.00)°vs (89.85 ± 15.61 )°vs (58.95 ±9.87)°, (27.68±10.66) ms vs (26.15 ±13.02) ms vs (15.63 ±8.35) ms, (25.06±34.23) ms vs (2. 62 ± 60. 31 ) ms vs ( - 23.66 ± 31.39) ms, F = 41.54,8.55,6.81, all P ＜ 0.01 ), however, there was no significant difference between Groups A and B ( t = 0. 68, 0.68, 1.30, all P ＞ 0.05 ). LV Sep-RV Delay and LV-RV Delay were significantly different among the three groups ( LV Sep-RV Delay: Group A (57.60 ±56.77) ms, Group B (6.36 ±61.88) ms, Group C ( -41.89 ±35.78) ms; LV-RV Delay:Group A (47.36 ±42.59) ms, Group B ( 3.08 ± 38.81 ) ms Group C ( - 26.50 ± 20.99 ) ms, F = 20. 32,25.38, both P ＜ 0.01 ). Conclusion Both RVA and RVOT pacing increase the segmental phases detected by GBPS, causing inter- and intra- ventricular asynchrony compared with patients without pacemakers.%目的 采用平衡法门控断层心室显像(GBPS)比较右室流出道(RVOT)和右室心尖部(RVA)起搏患者的心脏收缩同步性.方法 因三度或高度房室传导阻滞植入起搏器的患者50例,其中RVOT起搏组(A组)23例,RVA起搏组(B组)27例.另取24例初次化疗前肿瘤患者为对照组(C组),对照组经心脏超声检查证实心脏结构和功能正常,既往无心脏疾病史.3组患者均行GBPS检查,获得相角程(PS)、各壁段平均位相、各壁段平均位相标准差(SD)、室间隔与左室侧壁延迟(LV Sep-Lat Delay)、室间隔与右室延迟(LV Sep-RV Delay)和左右室延迟(LV-RV Delay)等同步性数据,采用单因素方差分析对3组患者心室同步性参数进行比较.结果 A、B组中共分析48例患者.A、B 2组的左室侧壁平均位相均高于C组,分别为(120.50±40.58)ms、(103.23±28.34)ms、(84.63±22.38)ms(F=7.72,P＜0.05),但A、B 2组间差异无统计学意义(t=1.30,P＞0.05).右室游离壁平均位相3组间的差异均有统计学意义(F=35.55,P＜0.01),A组为(137.05±39.27)ms,高于B组的(100.85±23.79)ms和C组的(59.13±30.52)ms.A、B 2组的PS、SD和LV Sep-Lat Delay均高于C组,差异有统计学意义(F=41.54,P＜0.01),PS:A组(85.73±12.00)°,B组(89.85±15.61)°与C组(58.95±9.87)°;SD:A组(27.68±10.66)ms,B组(26.15±13.02)ms与C组(15.63±8.35)ms(F=8.55,P＜0.01);LV Sep-Lat Delay:A组(25.06±34.23)ms,B组(2.62±60.31)ms与C组(-23.66±31.39)ms(F=6.81,P＜0.01),但A、B 2组间差异无统计学意义(t=0.68,0.68,1.30,P均＞0.05).A、B、C组间LV Sep-RV Delay[(57.60±56.77),(6.36±61.88)和(-41.89±35.78)ms]和LV-RV Delay[(47.36±42.59),(3.08±38.81)和(-26.50±20.99)ms]差异均有统计学意义(F=20.32,25.38,P均＜0.01).结论 不论是RVA起搏还是RVOT起搏,起搏器植入术后患者心脏均存在节段性位相增加,左室内及双室间同步性均比未植入起搏器差.
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