右心室起搏比例和不同部位起搏对老年患者心功能的影响

目的：探讨右心室起搏比例和不同部位起搏对老年患者心功能的影响。方法回顾性分析92例植入体内埋藏式双腔心脏起搏器（DDD）的老年患者的临床资料，根据术后1年起搏器程控仪获取的右心室起搏比例，将右心室起搏比例≥50%患者纳入A组，右心室起搏比例＜50%患者纳入B组，比较两组术前和术后1年彩色多普勒心脏超声的变化。同时，将A组分为右室心尖部（RVA）起搏者和右室间隔部（RVS）起搏者进行亚组分析。结果 A组术后1年左房内径（LAD）较术前增大，左室射血分数（LVEF）较术前和B组降低，差异均有统计学意义（t分别=2.43、4.20、6.37，P均＜0.05）；B组术后1年LAD、左室舒张末期内径（LVEDD）、LVEF和术前比较，差异均无统计学意义（t分别=0.73、0.78、1.16，P均＞0.05）。亚组分析结果显示两亚组术前LAD、LVEDD、LVEF比较，差异均无统计学意义（t分别=0.77、0.35、1.32，P均＞0.05），两组术后LVEDD、LVEF比较，差异均有统计学意义（t分别=2.86、4.62，P均＜0.05），RVS组术后LAD、LVEDD、LVEF与术前比较，差异均无统计学意义（t分别=1.45、0.14、0.48，P均＞0.05）；而RVA组术后LAD、LVEDD均较术前明显扩大，LVEF较术前明显下降（t分别=2.20、3.13、4.31，P均＜0.05）。结论老年患者中右室间隔部起搏与右室心尖部起搏相比更有利于保持患者心功能的稳定，但同时应尽量减少不必要的右心室起搏。

Effect of percentage of right ventricular pacing and different pacing area on cardiac function in elderly patients

Objective To investigate the effect of percentage right ventricular pacing （%RVP） and different pacing area on cardiac function in elderly patients. Methods A total of 92 elderly patients with dual-chamber pacemakers （DDD） were divided into two groups according to %RVP at first year after implantation of pacemakers. The patients whose %RVP≥50%were selected into group A while%RVP〈50%were selected into group B. Echocardiographic parameters were measured by two-dimensional pulsed Doppler echocardiography and compared before and after operation. Furthermore, the group A were divided into right ventricular septum （RVS） pacing and right ventricular apex （RVA） pacing for subgroup analyzing. Results Left atrial diameter （LAD） in group A was significantly larger than in group B, Left ventricular ejection fraction （LVEF）was significantly lower than pre-operation and LVEF was significantly lower than group B （t=2.43, 4.20, 6.37,P〈0.05）. Compared with pre-operation, LAD, left ventricular end diastolic dimension （LVEDD）and LVEF post-operation in group B were not significantly different （t=0.73, 0.78, 1.16, P〉0.05）. Subgroup analysis showed that LAD, LVEDD and LVEF between two groups at preo-peration had no statistical difference （t=0.77, 0.35, 1.32,P〉0.05）. LVEDD and LVEF had significantly difference between RVA pacing group and RVS pacing group at post-operation （t=2.86, 4.62,P〈0.05）. LAD , LVEDD and LVEF in RVS pacing group were not significantly enlarged when compared pre-operation with post-operation （t=1.45, 0.14, 0.48,P〉0.05）. LAD and LVEDD at post-operation were significantly larger than that at pre-operation while LVEF was significantly lower （t=2.20, 3.13, 4.31,P〈0.05）. Conclusions Compared to RVA pacing,RVS pacing has more advantage on cardiac function in elderly patients. But it should be reduce unnecessary right ventricular pacing.