应用实时三维超声心动图评价DDD模式 右心室不同部位起搏对左心功能的影响

目的探讨应用实时三维超声心动图评价房室顺序双心腔起搏、感知触发和抑制型(DDD)模式右心室不同部位起搏对左心功能的影响。方法 20例DDD模式起搏器植入患者行右心室电极室间隔(RVS)及右心室心尖部(RVA)起搏,其中最终10例行RVS起搏,10例行RVA起搏。术后应用实时三维超声心动图随访6个月及1年,观察左心功能变化,检测指标包括:左心室射血分数(LVEF)、每搏量(SV)、左心室舒张末期容积(LVEDV)、收缩末期容积(LVESV)。结果术后6个月,RVS起搏组10例患者LVEF 54%±5%、SV(46.2±6.8)ml与术前LVEF 53%±6%、SV(43.2±5.4)ml比较差异无统计学意义(P0.05),RVA起搏组10例患者INEF46%±6%、SV(34.3±5.8)ml与术前INEF 54%±8%、sV(42.3±6.8)ml比较均减低(P0.05),此时两组LV-EDV、LVESV较术前变化差异不明显;术后1年随访,RVS起搏组10例患者LVEF 54%±6%、SV(44.1±8.4)ml与术前比较,差异无统计学意义(P0.05),RVA起搏组10例患者LVEF 43%±9%、SV(31.5±8.2)ml与术后6个月比较进一步减低(P0.05),RVS起搏组LVEDV、LVESV较术前仍变化不明显(P0.05),RVA起搏组10例患者LVEDV(71.2±8.1)ml、LVESV(41.8±6.1)ml均较术前LVEDV(68.5±10.7)ml、LVESV(27.1±3.4)ml增大。结论长期的RVS起搏对左心功能无明显影响,而RVA起搏可降低左心功能,并造成左心室重构的风险加大。

Impact of pacing in different parts of right ventricle on left ventricular function:evaluation with real-time three dimensional echocardiography

Objective To evaluate left ventficular function with real-time three-dimensional echocardiography after dual-chamber pacemaker （ DDD mode） implantation with different pacing parts of right ventricle. Methods A total of 20 patients with DDD pacemaker were enrolled. Ten received regular fight ventricular septal （RVS） pacing, while the other 10 received fight ventricular apical （RVA） pacing. Real-time three-dimensional echocardiographys were performed at 6 months and one year after procedures to detect left ventficular function including left ventricular ejection fraction （ LVEF）, stroke volume （SV）, left ventricular end-diastolic volume （LVEDV） and left ventricular end-systolic volume （LVESV）. Results After 6 months, LVEF （ 54% ± 5% ） and SV （46. 2 ± 6. 8 ） ml） ] in RVS pacing group showed no difference compared with those before procedures LVEF （ 53 % ± 6% ）, SV （43.2 ± 5.4 ） ml ], while in RVA pacing, group, LVEF and SV were rcduced 46% ＋6% vs. 54% ±8%, （34. 3 ±5.8） ml vs. （42. 3±6. 8） ml both P 〈0. 05]. LVEDV and LVESV had no changes in both groups compared with before （ both P 〉 0. 05 ）. At 1 year of follow-up, LVEF and SV in RVS pacing group still had no changes compared with pre-procedure 54% ± 6% , （44. 1 ± 8.4 ） ml, P 〉 O. 05 ）], RVA pacing group had significant reduction compared with those at 6 months 43% ± 9%, （31.5 ± 8.2） ml, P 〈0. 05 ]. LVEDV, LVESV in RVS pacing group had no change compared with those before procedure （ both P 〉 0.05）, while in RVA pacing group, LVEDV and LVESV were increased than before （71.2 ±8. 1 ） ml vs. （68. 5 ± 10. 7 ） ml, （41.8 ± 6. 1 ） ml vs. （27. 1 ± 3.4） ml]. Conclusions LV function has no significant change with long-term RVS pacing, while RVA pacing can reduce LV function and cause left ventricular remodeling.