重度三尖瓣反流患者右心室起搏部位的选择

目的 比较重度三尖瓣反流患者起搏导线放置在心尖部或流出道间隔部的难易程度.方法 2013年1月至2013年10月复旦大学附属中山医院40例符合起搏器植入适应证合并重度三尖瓣反流的患者,按随机表将其随机分成A组（拟行流出道间隔部起搏）与B组（拟行右心室心尖部起搏）.术前测定所有患者右心室体部与流出道短轴缩短分数.术中记录2组植入心室导线的曝光时间和术中脱位情况.比较术中及术后3个月流出道间隔部起搏与心尖部起搏的阈值,感知、阻抗等电极参数.结果 A、B两组各20例,A组术中曝光时间显著短于B组[（113.5±33.8）s对（156.3±58.1）s,P=0.007],A组仅1例（5.0％）发生术中脱位,B组6例（30.0％）发生术中脱位,并行导线重置,差异有统计学意义（P=0.037）.两组间术中及术后3个月起搏导线参数差异无统计学意义.所有受试者右心室体部短轴缩短分数（FS）显著大于流出道（33.7％±5.4％对27.1％±4.4％,P＜0.01）.结论 重度三尖瓣反流患者将心室导线固定于右心室流出道间隔部比心尖部更为简单易行.

Choice of right ventricular pacing site for patients with severe tricuspid regurgitation

Objective To determine a more easily located right ventricular pacing site for patients with severe tricuspid regurgitation.Methods A total of 40 patients from Zhongshan Hospital,Fudan University,who had indications for permanent pacemaker implantation accompanied with severe tricuspid regurgitation were enrolled.They were randomized into two groups：group A （designed for right ventricular outflow tract septum pacing） and group B（designed for right ventricular apex pacing）.The short-axis fractional shortening（FS） at right ventricular（RV） body and right ventricular outflow tract（RVOT） were acquired before implantation.The time of X-ray exposure for ventricle lead location and number of repositions were documented during implantation.We also made a comparison of pacing parameters （including pacing thresholds,amplitude of R-wave and impedances） between RV apex and RVOT septum pacing,both in the course of implantation and 3 months after implantation.Results There were 20 patients in group A and group B respectively.X-ray exposure time required for ventricle lead placement in group A was significant shorter than in group B[（113.5±33.8） s vs.（156.3± 58.1） s,P =0.007].Lead dislogrnent was observed in one case （5.0%）for group A while 6 cases （30.0%）for group B during implantation,all underwent lead reposition （P=0.037）.No significant difference of lead parameters was noted between the two groups.All subjects demonstrated significantly larger short-axis FS at RV body than at RVOT（33.7%±5.4% vs.27.1%±4.4%,P〈0.01） . Conclusion For patients with severe tricuspid regurgitation,active-fixation lead could be more easily attached to RVOT septum than to RVA.