3830电极在右室间隔起搏的临床应用

目的比较Medtronic3830主动固定导线在右室间隔（高位室间隔部和中位室间隔部）起搏的优劣。方法71例需起搏器植入的患者，根据心室电极位置的不同，随机分为高位室间隔组（n：35）和中位室间隔组（n=36），观察两组在术中及术后3个月的各项心室电极参数以及起搏器植入术前、术后3个月的左室射血分数（LVEF）、血浆脑钠肽（BNP）。结果电极全部植入成功，术后未发生导线脱位或心肌穿孔。中位室间隔组QRS波时限要短于高位室间隔组（116±23．6）InsVS（150±34．2）ms，P〈0．05]。中位室间隔组术前及术后3个月LVEF、BNP无显著改变，高位室间隔组术前及术后3个月LVEF降低（0．46±0．12）％Vs（0．62±0．07）％]，P〈0．05]、BNP升高（161．3±34．2）ng／LVS（80．1±33．2）ng／L，P〈0．05]。术中及术后3个月两组的心室起搏阈值、阻抗、感知无差异。结论采用3830主动电极行右室间隔部起搏可行，右室中位间隔起搏QRS波时限更短，对心功能无显著影响。

Clinical application of Medtronic 3830 active-fLxation lead in right ventricular septum pacing

Objective To compare the difference of Medtronic 3830 active fixation leads with high- right ventricular septum pacing and middle septum pacing. Methods 71 patients with pacemaker implantation indication were randomly divided into two groups. All patients underwent high-right ventricular septum pacing or middle septum pacing with Medtronic 3830 active fixation leads. The parameters, LVEF and BNP of two groups were recorded during and three-month after procedure and compared accordingly. Results Procedures in two groups came off smoothly and there were no subjects with lead dislocation or perforation. QRS duration in middle septum pacing group was shorter than high-right ventricular septum pacing group （116 ±23.6）ms VS （150 ± 34. 2）ms, P 〈 0. 05 ]. In the high-right ventricular septum group, B NP increased significantly （161.3 ± 34.2） ng/L VS （80. 1 ± 33.2） ng/L,P 〈 0.05 ] and LVEF had down trends at the three-month （0. 46 ±0. 12） % VS （0. 62±0. 07） % ,P 〈0.05 ]. There was no significant difference in pacing threshold, impedance and sensa- tion between two groups during procedure and three months after the procedure. Conclusion Right ventricular septum pacing with Medtronic 3830 active fixation leads is feasible, but it is a better choice for middle septum pacing with short QRS duration and less impact on BNP level and LVEF.