高位右室间隔起搏与右室心尖部起搏的临床对照研究

摘要

Objective To investigate the effects of right high ventricular septal( HRVS ) pacing on ventricular systonic synchronization and heart function so as to evaluate the security and fesibility. Methods One handred and seventy patients who received implanting pacemaker were divided into HRVS pacing group (n = 87) and right ventricular apex( RVA) pacing group ( n = 83 ) randomly. The Pacing parameters and duration of QRS were measured immediately after placement and would be measured a-gain one month later. Synchronization index were measured by Tissue Doppler Imaging after three month and Left ventricula rejection fraction ( LVEF) and Left ventricular end-diastolic diameter (LVEDD) were measured by echocardiography in 3 months,6 months and one year after the implantation. Results There was no significant difference in the pacing threshold, sense threshold and impedance between HRVS pacing group and RVA pacing group at the moment of implantation and one month later. The duration of QRS was significant shorter in HRVS than that in HVA. TDI showed significant difference in synchronizing between RVA pacing group and HRVS pacing group( P < 0.01). Statistical data in HRVS pacing group reached Synchronization standard . LVEF was higher in HRVA group than that in RVA group in 3 months ,6 months and one year after the implantation. LVEDD haven't significant difference within one year between the two group. There haven't electrode dislocation and myocardial perforation during one year followed up. Conclusion HRVS pacing is more benefit to maintain ventricular systonic synchronization and have less affection in systolic function of left ventricular than HVA pacing . Right high ventricular septal( HRVS ) pacing is safety and feasible.%目的 探讨高位右室间隔(HRVS)起搏对心室收缩同步性和心功能的影响以进一步评价其安全性和实用性.方法 170例置入起搏器的患者,随机分成右室心尖部(RVA)起搏组(RVA组,n=83)和右室间隔起搏组(HRVS组,n =87).分别测量两组成功置入后即刻和术后1个月起搏参数及心电图、术后3个月组织多普勒同步性指标、术后3个月、6个月、1年左室射血分数(LVEF)和左室舒张末期内径(LVEDD)及观察随访1年中有无并发症.结果 成功置入后即刻及术后1个月HRVS组与RVA组在起搏阈值、感知阈值及阻抗方面均无明显差异,HRVS组比RVA组QRS波明显更窄.组织多普勒(TDI)检测RVE组与HRVS组同步性指标差异有统计学意义(P＜0.01),HRVS组三项差值均达到同步标准,RVAP组三项差值均不同步.术后3个月、6个月、1年时的LVEF值,HRVS组高于RVE组(P＜0.05),随着时间延长,统计学意义差异更加显著(P＜0.01).术后3个月、6个月、1年左室舒末内径差异无统计学意义.1年随访中未发现电极脱位、心肌穿孔等并发症.结论 HRVS起搏较RVA起搏更有利于了保证心室收缩的同步性,对左室收缩功能的影响较小.高位右室间隔起搏是安全可行的,值得临床推广.