间隔部主动固定电极对老年患者心功能的影响

目的探讨右室间隔部（RVS）主动固定电极对植入永久起搏器的老年患者心功能的影响。方法入选78例植入永久起搏器的老年患者，分为RVS起搏组（实验组，植入主动固定电极，n=42）和右室心尖部（RVA）起搏组（对照组，植入被动固定电极，n=36），以超声心动图评价两组术前、术后6个月左室缩短率（FS）、每搏输出量（SV）、心输出量（CO）、左室射血分数（LVEF）、E／AI：L值的差异。结果术前两组心功能状况无明显差异（P〉0．05）。术后6个月，RVS起博组与术前相比较，FS、SV、CO、EF、E／A虽有下降趋势，但差异无统计学意义（P〉0．05）；RVA起博组在术后6个月FS与对照组差异无统计学意义（P〉0．05），但SV、CO、EF、E／A均高于RVS起博组（P〈0．05）。两组起搏阈值、感知、阻抗起搏比例及平均心率等差异均无统计学意义（P〉0．05）。结论RVS起搏对患者心功能的影响优于右室心尖部起搏。

Impact of right ventricular septal active fixation lead on cardiac functions in elderly patients

Objective To investigate the impact of right ventricular septal （RVS） active fixation lead on cardiac functions in elderly patients implanted with permanent pacemakers. Methods A total of 78 patients at an average age of 71.9 ＋ 6.7 implanted with permanent pacemakers in our hospital during June 2008 to May 2011 were enrolled into this study. They were divided into 2 groups according to their own will of which type of pacemaker, that is, RVS pacing group （experiment group, implanted with active fixation lead, n = 42） and right ventricular apical （RVA） pacing group （control group, implanted with passive fixation lead, n = 36）. Their fractional shortening （FS）, stroke volume （SV）, cardiac outcome （CO）, left ventricular ejection fraction （LVEF） and E/A ratio （early to late atrial ventricular filling velocity） were evaluated by echocardiography before and 6 months after implantation. Results No significant difference in cardiac functions was found between the 2 groups before implantation （P 〉 0.05）. A trend of decrease was found in FS, SV, CO, LVEF, and E/A ratio in RVS pacing group in 6 months after implantation though without significant difference （P 〉 0.05）. Despite that RVA pacing group had no difference in FS compared with RVS pacing group in 6 months after implantation, it had significantly higher SV, CO, LVEF, and E/A ratio （P 〈 0.05）. There was no difference in pacing threshold, perception, impedance pacing rate, and mean heart rate between the 2 groups （P 〉 0.05）. Conclusion RVS pacemaker implantation is superior to RVA pacemaker implantation in cardiac functions for senile patients.