不同起搏部位的选择对起搏器植入患者影响的随机对照研究

目的 探讨右室间隔部（RVS）起搏与右室心尖部（RVA）起搏对起搏器植入患者心功能及远期预后的影响.方法 选取249例因窦房结功能障碍或房室传导阻滞导致的缓慢型心律失常行起搏治疗的患者,随机分为两组：RVA起搏组（简称RVA组）147例,采用被动固定翼状电极行RVA起搏;RVS起搏组（简称RVS组）102例,采用主动固定螺旋电极行RVS起搏.对比两组术前、术后3年超声参数：包括左房内径（LAD）、左室舒张期（LVEDD）、左室收缩末期内径（LVESD）、左室射血分数（LVEF）以及术后3年内新发房颤情况、因心力衰竭住院情况等.结果 RVA组与RVS组比较,术后3年LAD变化不明显,差异无统计学意义（P＞0.05）;RVA组LVEDD、LVESD较RVS组明显扩大,LVEF则明显下降,差异有统计学意义（P＜0.05）.结论 RVS起搏与RVA起搏相比,可明显改善患者的心功能及预后,为临床更为接近生理性的起搏部位.

Study of Pacemaker Implantation In Patients with Different Pacing Site

Objective To evaluate the right ventricular septum （RVS） pacing and right ventricular apex （RVA） pacing on the prognosis of patients implanted with influencing heart pacemakers and the long-term effects. Methods 249 cases with sinus node dysfunction or atrioventrieular block resulted from the slow type arrhythmia for pacing patients were randomly divided into two groups. Among them, RVA pacing group of 147 cases used passive fixation of electrode for RVA pacing; RVS pacing group of 202 cases used active fixation electrode for RVS pacing. Ultrasound parameters were compared between the two groups before operation and after 3 years, including the left atrial diameter （LAD）, left ventricular diastolic （LVEDD）, left ventricular end systolic diameter （LVESD）, left ventricular ejection fraction （LVEF）, and after 3 years the number of new-onset AF and hospitalization for heart failure. Results Comparing RVA group with RVS group after 3 years, LAD of RVA did not change significantly, the difference was not statistically significant （P~0.05） ; In RVA group, LVEDD, LVESD was higher than that of RVS group, LVEF decreased, the difference was statistically significant （P〈0. 05）. Conclusion Compared with RVA pacing, RVS can improve heart function and the prognosis for patients, clinical more physiological pacing site.