不同部位及不同方式心房起搏对心房激动的影响

目的 了解不同部位、不同方式心房起搏时P波、P－R间期以及心房激动顺序的特点，从而寻找最佳的心房单部位起搏方式。方法 对20例射频消融成功后的患者，分别放置高位右房、右心耳、Koch三角、希氏束以及冠状窦电极，若为左侧旁路则加置左心房电极，行不同部位、不同方式心房起搏。结果 Koch三角、Koch三角＋高位右房、左房、双房起膊时P波宽度、P－R间期无差异，但右心耳起搏时各导联P波增宽，P－R间期延长。从心房激动顺序分析，右心耳起搏时，激动传至希氏束区及冠状窦区的时间最长，而Koch三角、Koch三角＋高位右房及双房起搏时则较短，尤其是Koch三角、Koch三角＋高位右房起搏缩短更明显。另外，不同部位、不同方式起搏时右心房压力无差异。结论 Koch三角起搏在某种程度上可替代高位右房＋冠状窦起搏及双房起搏。

Effects of atrial pacing with different sites and modes on atrial activation

Objective With understanding characteristics of the P wave, P R interval and atrial activation by atrial pacing of different sites and modes to seek the optimum atrial single site pacing Methods The quadripolar electrode catheters were placed at high right atrium, right atrial appendage, Koch triangle, His bundle, and coronary sinus respectively in 20 patients after successful ablation, the catheter was also introduced in left atrium in patients with left accessory pathway, then the atrial pacing was performed with different sites and modes Results There were no significant differences in P wave duration, P R interval among pacing at Koch triangle, Koch triangle with high right atrium, left atrium and biatria ( P >0 05). The P wave duration and P R interval were increased while pacing at right atrial appendage The activation time from pacing site to His bundle and coronary sinus was the longest in pacing at right atrial appendage, while the activation time in pacing at Koch triangle, Koch triangle with high right atrium and biatria was significantly shorter especially pacing at Koch triangle and Koch triangle with high right atrium There were no significant differences in right atrium pressure among all pacings Conclusion It is suggested that Koch triangle pacing could probably replace high right atrial with coronary sinus pacing and biatrial pacing