长期右室心尖部起搏对心室重构及心功能的影响

目的观察长期右室心尖部起搏对临床、心室重构和心功能的影响,为起搏电极植入部位提供参考。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。病因为高度和Ⅲ度房室传导阻滞;安装时无严重基础心脏病和心脏扩大,心功能正常,安装起搏器到随访时间大于5年,起搏比率80%。比较起搏器置入前后心脏超声参数、心功能和临床状况等指标。结果研究共入选82例。两次评估相隔的平均时间是8.7年(104.4个月)。植入起搏器后左房内径增大,左室射血分数降低(P均0.001),而左室舒张末内径无明显改变。有4例(占4.87%)出现了心室重构且伴有心功能分级恶化,其中3例为植入起搏器后发生前壁心肌梗死,1例为2型糖尿病。未发生心室重构的患者均没有临床心力衰竭症状。结论心脏结构及心功能正常患者长期右室心尖部起搏,一般不会发生心室重构及临床心功能恶化。

Effects of long-term right ventricular apical pacing on left ventricular remodeling and cardiac function

Objective To investigate the impacts of long-term right ventrieular apical pacing on the ventricular remodeling and cardiac functions of patients with arrhythmia. Methods Study participants were admitted for pacemaker replacements and who revisited for examinations of implated pacemakers at outpatient. Pacemakers were implanted to treat highgrade and third-degree atrioventricular block. At the time of pacemaker implantation, patients had normal cardiac functions and showed no serious heart diseases or cardiac dilatation. The durations from the implantation to follow-up were more than 5 years. The pacing rate was higher than 80%. The echocardiography parameters, cardiac functions and clinic conditions at implantation and after implantation were compared respectively. Results A total of 82 patients were enrolled in this study. The average duration between two times of assessments was 8.7 years （ 104.4 months）. After pacemaker implanta- tion, the average left atrial diameter （LA） enlarged, Left ventricular ejection fraction（LVEF） decreased（ all P 〈 0. 001 ）, and four patients （4.87%） had ]eft ventricular remodeling with deterioration of cardiac function. Among them, three pa- tients had anterior wall myocardial infarction after implantation and one had type II diabetes. Heart failure symptoms were not found in patients without ventrieular remodeling. Conclusion Long-term right ventricular apical pacing in patients with normal heart structure and cardiac function generally do not cause ventricular remodeling and clinical deterioration of cardiac function. [ Chinese Journal of Cardiac Pacing and Electrophysiology ,2010,24 （2） ：140 -142 ]