右心室流入道起搏QRS波时限对心功能的影响

目的观察采用右心室流入道起搏治疗缓慢性心律失常时,QRS时限对心功能的影响及与心力衰竭的关系。方法随意选用44例病态窦房结综合征或Ⅲ度房室传导阻滞的患者,采用右心室流入道起搏治疗,将患者起搏时QRS时限133m s的分为A组(n=28);起搏时QRS时限≥133m s的分为B组(n=16),测量起搏器植入时、起搏3个月和6个月不同时期,QRS时限、血浆心钠肽(BNP)、心排血量(CO)、每搏输出量(SV)、射血分数(EF)和左室舒张末内径(LVDd)的变化。结果术后即刻测两组QRS时限、BNP值和心脏超声指标无显著性差异(P0.05)。术后3个月、6个月QRS时限、LVDd、BNP,B组明显高于A组,而EF、SV、CO,B组明显低于A组。结论右室流入道起搏部位QRS时限和心功能密切相关。QRS时限越宽,心功能纠正就越不明显或心衰进一步加重;反之,QRS时限越窄,心功能改善就越明显。

Influence of QRS Interval on Cardiac Function in Patients Treated by Right Ventricular Inflow Tract Pacing

Objective To observe the impact of QRS interval on cardiac function and its relationship with the heart failure when using right ventricular inflow tract pacing in patients with slow arrhythmias.Method 44 patients with sick sinus syndrome or third degree atrioventricular block were randomly selected and treated with right ventricular inflow tract pacing.The patients were divided into group A（n=28） whose QRS interval133ms when be paced and group B（n=16） whose QRS interval≥133ms when be paced.QRS interval,plasma cardiac natriuretic peptide（BNP）,cardiac output（CO）,stroke volume（SV）,ejection fraction（EF） and left ventricular end diastolic diameter（LVDd） changes were measured when pacemaker implanted,pacemaker implanted 3 months and 6 months later.Results Immediately after testing,there was no significant difference（P0.05） in QRS time,BNP values and the parameters of echocardiography between two groups.After 3 and 6 months,the parameters of QRS time,LVDd,BNP in group B were significantly higher than those in group A.While EF,SV,CO,in group B were significantly lower than those in group A.Conclusions At the right ventricular inflow tract pacing site,QRS duration is closely related to cardiac function.The wider QRS time frame,the less obvious the improvement of cardiac function or the more exaggerated the heart failure.Whereas,the more narrow QRS time frame,the more obvious the improvment of heart function.