DDD起搏器选择心室起搏部位对血流动力学的影响

目的比较右室间隔部(RVS)和右室心尖部(RVA)起搏对血流动力学的影响。方法42例置入DDD起搏器的患者,分为RVS组和RVA组;比较2组术前和术后3个月随访的左室射血分数(LVEF)、心脏指数(CI)、每搏量(SV)、左室最大压力上升速率(dp/dtmax)、左室最大压力下降速率(-dp/dtmax)、二尖瓣血流E峰和A峰最大充盈速度比值(E/A)、等容舒张时间(IVRT)差异。结果与术前相比,RVA组3个月随访的LVEF、CI、SV、dp/dtmax、-dp/dtmax、E/A、IVRT均显著降低(0.51±0.04vs0.54±0.03;2.33±0.09L/min.m-2vs2.68±0.11L/min.m-2;71.11±14.2mlvs80.17±16.12ml;1614±133mmHg/svs1702±155mmHg/s;2230±234mm-Hg/svs2404±242mmHg/s;1.38±0.47vs1.86±0.28;73.2±3.86msvs77.6±4.15ms,均P<0.05),RVS组无明显变化。3个月随访RVS组LVEF、CISV、SV、dp/dtmax均显著高于RVA组(P<0.05)。结论RVS起搏对血流动力学无不良影响。

Effects of ventricular pacing ways on hemodynamics in patients with implanted DDD pacemakers

Objective To compare the hemodynamic effects of right ventricular septum(RVS) pacing and right ventricular apex(RVA) pacing in patients with implanted DDD pacemakers. Methods 42 cases with implanted DDD pacemakers were randomly divided into RVS group and RVA group; left ventricular ejection fraction(LVEF),cardiac index(CI) ,stroke volume(SV), maximum rate of left intraventricular pressure rise/down (±dp/dt max), mitral E/A ratio, isovolume relaxation time(IVRT)of two preoperation groups and after operation groups with 3-month following-up were compared. Results Compared with pre-operation, LVEF、CI、SV、dp/dt max、-dp/dt max、E/A 、IVRT in RVA group decreased significantly(0.51±0.04 vs 0.54±0.03;2.33±0.09 L/min·m-2 vs 2.68±0.11 L/min·m-2; 71.11±14.2 ml vs 80.17±16.12 ml ;1 614±133 mmHg/s vs 1 702±155 mmHg/s ;2 230±234 mmHg/s vs 2 404±242 mmHg/s ;1.38±0.47 vs 1.86±0.28;73.2±3.86 ms vs 77.6±4.15 ms,all P<0.05),no significant change in RVS group. Compared with RVA group , LVEF、CISV、SV、dp/dt max in RVS group increased significantly after 3-month follow-up. Conclusions RVS pacing has no negative effects on haemodynamics.