右心室流入道间隔部起搏对心功能的影响

目的 探讨右心室流人道间隔部(BVIS)起搏对心功能的影响.方法 将64例患者按心室电极固定部位不同分为RVIS组(33例)和右心室心尖部(RVA)组(31例),观察两组起搏器置入术后24 h、3个月、12个月时的Ⅱ导联QRS波时限、起搏参数(起搏电压域值、电极阻抗)及血浆脑利钠肽(BNP)水平的变化.结果 两组起搏参数研究期间均稳定且差异无统计学意义;起搏器置入术后24 h、3个月、12个月RVIS组ORS波时限明显短于RVA组[(128.0 ±28.6)、(131.0 ±21.5)、(130.0±19.7)ms比(150.0±37.1)、(153.0±28.5)、(155.0±20.2)ms,P<0.05].治疗后两组血浆BNP水平均较起搏前增加,且RVIS组显著低于RVA组(P<0.05).结论 RVIS起搏较RVA起搏对心功能的影响更小,更符合生理性.

Influence of right ventricular inlet septum pacing on heart function

Objective To investigate the changes of heart function after pacing in right ventricular inlet septum(RVIS) and right ventricular apex(RVA). Methods VVI pacing was performed in 64 patients who were randomly divided into two groups: RVIS group (33 patients) and RVA group (31 patients). The changes of serum brain natriuretic peptide (BNP),pacing parameters and QRS interval were assessed in 24 hours, 3 months and 1 year after the ventricle was paced effectively. Results When the ventricle was paced effectively,the pacing parameters,including voltage threshold and electrode impedance were similar in different stages between the two groups. In 24 hours, 3 months and 1 year after the ventricle was paced effectively,the QRS interval in RVIS group were obviously narrower than those in RVA group [( 128.0±28.6 ) ms vs ( 150.0 ± 37.1 ) ms, ( 131.0±21.5 ) ms vs ( 153.0 ±28.5 ) ms, ( 130.0 ±19.7 ) ms vs ( 155.0±20.2) ms, P < 0.05 ]. After treatment, the level of serum BNP increased significantly in two groups. The BNP level in R VIS group was significantly lower than that in RVA group (P < 0.05). Conclusion The R VIS pacing is not only as safe and effective as RVA pacing, but also is more consistent with the physiological ventricular activation sequence.