右心室不同起搏部位对患者心功能的影响

摘要

目的 探讨右心室间隔部(RVS)起搏与心尖部(RVA)起搏对起搏依赖性患者心功能的影响.方法 选择植入双腔起搏器的三度房室传导阻滞患者(63例),按心室电极固定部位不同随机分为RVA起搏组(RVA组)32例及RVS起搏组(RVS组)31例.观察两组术前与术后6个月心电图QRS波宽度和形态;比较两组术前与术后6个月血清NT-proBNP水平及左室射血分数(LVEF)变化.结果 术前两组QRS间期差异无统计学意义,术后6个月随访检测QRS间期,两组都有所增加,但RVA组起搏心电图Ⅱ导联QRS间期显著长于RVS组f(0.18±0.03)s vs(0.14±0.01)s,P<0.05];术前两组血清NT-proBNT水平差异无统计学意义,术后6个月随访检测血清NT-proBNP水平,两组都有所增加,但RVA组较RVS组显著升高[(286.8±5.2)pg/ml vs(212.1±6.6)pg/ml,P<0.05];左室射血分数术前及术后无明显变化.结论 RVA起搏扰乱了双心室电同步,可能恶化了血流动力学和心功能,RVS起搏尽可能的维持了双心室激动顺序和双心室收缩同步性,对血流动力学影响较小,RVS起搏比RVA起搏更加符合生理的起搏部位.与RVA起搏比较,RVS起搏有利于保持心肌电活动和机械收缩的同步性.%Objective To investigate the Influence of different parts of the right ventricular on heart functions of patients with DDD pacemaker. Methods 63 patients with Ⅲ° atrioventricular block were randomly divided into two groups, one group was underwent right ventricular apex (n=32); the other group was underwent right ventricular septum (n=3 I). The QRS waves, serum NT-proBNP level and the LVEF were recorded and analyzed before operation and followed up for 6 months between two groups. Results There was no difference on the QRS duration of lead II of the two groups before operation, but 6 months after operation, the QRS duration of lead 11 in RVA group was longer than that in RVS group dramatically([0.18±0.03]s vs [0.14±0.01]s, P<0.05). There was no difference on serum NT-proBNP of the two groups before operation, but 6 months after operation, the serum NT-proBNP of the two groups was significantly increased, it increased more in RVA group than that in RVS group([286.8+5.2] pg/ml vs [212.1±6.6]pg/ml, P<0.05). There was no difference on the LVEF of the two groups before operation and followed up for 6 months. Conclusion The RVA pacemaker disturbs the biventricular electrical synchrony and results in the deterioration of the homodynamic and cardiac function. The RVS pacemaker farthest keeps the normal sequence of electrical activity and the synchronous contraction and has less negative feet on the homodynamic. Therefore, RVS pacemaker is more physiological than RVA pacemaker.