不同右室起搏比率对房颤合并长R-R间期患者左心功能的影响

摘要

目的：观察单腔起搏器不同右室起搏比率对心房纤颤合并长R-R间期患者左心功能的影响及可能机制。方法：将24例持续性心房纤颤长合并R-R间期患者置入永久单腔心脏起搏器，根据右室起搏比率（Vp%）是否≥40%分为两组，病例组（Vp%≥40%）及对照组（Vp%<40%）。分别在出院前、1年、2年时随访，测定右室起搏比率，左心房内径（LAD），左室舒张末内径（LVEDD），左室射血分数（LVEF）。结果：两组在出院前LAD比较差异无统计学意义；病例组LAD在1年及2年时比较，差异有统计学意义；对照组与病例组的LAD变化趋势比较，有显著性差异；两组患者出院前与术后1年的LVEDD差异无统计学意义，两组LVEDD1年与2年时比较差异有统计学意义，两组2年时的LVEDD比较有统计学意义，两组LVEDD变化趋势比较有统计学意义；病例组LVEF的出院前、术后1年、2年改变有统计学意义。两组出院前、1年、2年时LVEF变化趋势无统计学意义。结论：右室起搏比率≥40%对于心房纤颤长合并R-R间期患者，引起LAD，LVEDD扩大， LVEF下降。%Objective:To explore observational single-chamber pacemaker ratio on left ventricular function and its possible mechanism.Method:24 cases successfully implanted a permanent single-chamber pacemakers were divided into two groups with Right-ventricular Pacemaker ratio greater or less than 40%.after implantation,before discharge,1 year, 2 years of follow-up determination the ratio of right ventricular pacing, left atrial diameter (LAD),left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF).Result:Two groups of left atrial diameter (LAD), the difference was not statistically significant;the two groups at before discharge,1 year compared to 2 years,the difference was statistically significant to 1 year and 2 years in Variation Trend of LVEDD and ejection fraction (LVEF);the difference statistically significant to comparison of two group in variation trend of LVEDD;no significant difference in variation trend of LVEF.Conclusions:Right-ventricular Pacemaker ratio with greater than 40% can increase left ventricular enlargement and the decline in cardiac function in patients with atrial fibrillation with long R-R interval.