长期右室心尖部起搏对三尖瓣返流的影响

目的探讨长期右室心尖部起搏对基础心功能正常患者三尖瓣返流的影响。方法入选更换起搏器的住院患者和门诊复诊的起搏器患者;所有入选患者于起搏器植入前和植入后均行二维及彩色多普勒超声心动图检查,比较植入前后三尖瓣返流程度的变化,并根据患者起搏器植入年限(≤6月、6个月至3年、≥3年)和心室起搏百分比(≤35%、≥85%)分别进行亚组分析比较各亚组的三尖瓣返流程度。结果共入选69例,两次超声心动图评估相隔时间6.5±4.6年。结果植入后三尖瓣轻微返流明显增加(P<0.01),而有临床意义(中、重度)的三尖瓣返流的发生虽有增加趋势但无差异(P>0.05);起搏器植入年限与心室起搏百分比各亚组之间新发或加重的三尖瓣返流无差异(P>0.05)。结论基础左心功能正常的患者长期右室心尖部起搏可引起三尖瓣的轻微返流,有临床意义或加重恶化的三尖瓣返流很少发生,且与起搏器植入年限、心室起搏百分比无明显相关。

Effects of long-term permanent right ventricular apical pacing on tricuspid regurgitation

Objective To evaluate the effect of permanent right ventricular apical(RVA) pacing on the degree of tricuspid regurgitation(TR) in subjects with normal basic heart function.Methods Patients who had implanted pacemaker were recruited in the study while they revisited for replacement or examinations of implanted pacemaker at outpatient.All patients underwent two-dimensional and Doppler echocardiographic evaluation before and after device implantation.According to different implant-timing of pacemaker(≤6 months,6 months to 3 years,≥3 years) and different cumulative percent of right ventricular pacing(≤35%,≥85%),the severity of TR in different subgroups were analysed and compared.Results Sixty-nine patients consisted of the study population.The average duration between two times of assessments was 6.5±4.6 years.Results showed that RVA pacing was associated with an significant increase in the number of trivial tricuspid regurgitation(P<0.01);there was no statistics significant increase in clinically meaningful TR(P>0.05).There were no significant differences in the new on-set or worsening of the severity of TR between each subgroups(P>0.05).Conclusions Among patients with normal basic left ventricle function,long-term permanent RVA pacing may cause the trivial TR.The signifitive or worsening TR is relatively rare after pacemakers implantation.It has not connection with implant-timing and cumulative percentage of right ventricular pacing.