缓慢性心律失常患者右心室流入道间隔部起搏治疗后神经内分泌激素及心功能的变化

目的：探讨缓慢性心律失常患者经右心室流入道间隔部（RVIS）起搏治疗后神经内分泌激素和心功能的变化。方法：56例缓慢性心律失常患者行双腔起搏器（DDD）治疗，心房起搏电极植于右心耳梳状肌内，心室电极植入RVIS。在起搏治疗时、治疗6个月后测定患者血浆环磷腺苷（cAMP）、环磷乌苷（cGMP）、肾素、血管紧张素（Ang）Ⅱ、醛固酮、脑钠肽和去甲肾上腺素（NE）水平；彩色多普勒超声测定患者心排血量、每搏输出量（SV）、LVEF、左心室舒张末内径（LVDd）和左心室短轴缩短分数（LVFS）。结果：RVIS起搏治疗6个月后，患者神经内分泌激素（cAMP、cGMP、肾素活性、Ang Ⅱ、醛固酮、脑钠肽和NE）水平较起搏治疗时明显下降；心功能较起搏时明显改善（心排血量、SV、LVFS和LVEF增加，LVDd降低）。结论：RVIS起搏治疗缓慢性心律失常可改善患者心功能，降低神经内分泌激素水平，防止心力衰竭发生，值得临床推广。

Effects on neuroendocrine hormone and cardiac function of right ventricular inlet septal pacing treatment in patients with slow arrhythmia

Objective ： To investigate the effects of right ventricular inlet septum （RVIS） pacing treatment on neuroendocrine hormone and cardiac function in patients with slow arrhythmia. Methods： Dual charmber pacemakers were implanted in 56 patients with slow arrhythmia. Atrial pacing electrode was implanted in the right atrial appendage comb muscle, while ventricular pacinq electrade was implanted in RVIS. Plasma cyclic adenosine monophosphate （cAMP）, cyclic guanosine monophosphate （cGMP）, renin activity, angiotensin Ⅱ （Ang Ⅱ）, aldosterone, B type natriuretic peptide and norepinephrine （NE） were measured, while cardiac output, stroke volume （SV）, left ventricular ejection fraction （LVEF）, left ventricular end diastolic diameter （LVDd） and left ventricular fractional shortening fraction （LVFS） were assessed according to Doppler ultrasonography at baseline and 6th month after implantation. Results： Significant reduction of neuroendocrine hormones, including cAMP, cGMP, renin activity, Ang Ⅱ , aldosterone, B type natriuretic peptide and NE, and improvement of cardiac function, including higher cardiac output, treatment. Conclusion： RVIS SV, LVFS and LVEF and lower LVDd, were observed at 6th month after pacing improves cardiac function and prevents patients from heart failure.