右室间隔部起搏对慢快综合征患者血流动力学及抗心律失常的研究

目的:探讨对慢快综合征患者行间隔部起搏后远期的血流动力学影响及间隔部起搏对阵发性房颤的控制效果。方法:需要植入DDD型起搏器的78例慢快综合征患者,按照心室电极的位置,随机分为右心室间隔部(RVS)起搏和右室心尖(RVA)起搏两组,对起搏器植入前、植入后第6个月和第12个月的QRS波宽度、左室射血分数、左室舒张末期内径、P波离散度、房颤负荷以及术中阈值、电极阻抗、感知差异进行分析。结果:术后6个月、12个月随访两组患者,RVS组患者QRS时限较术前有延长趋势但未达显著水平(P>0.05),RVA组患者QRS时限较术前显著延长(P<0.05);RVS组患者心功能和左室舒张末径较手术前无明显变化,RVA组患者心功能较手术前明显降低,左室舒张末径较手术前明显增加,两组相比,RVA组患者左室射血分数较RVS组患者低,两组左室舒张末期内径有明显差异(P<0.05);术后RVS组患者较术前P波离散度和房颤负荷无明显变化,而RVA组患者较术前P波离散度和房颤负荷增加。结论:右心室间隔部起搏是安全、有效的,右心室间隔部起搏将稳定或改善慢快综合征患者的远期心功能,最大限度减少阵发性房颤的发作。

The Effects of Right Ventricular Septum Pacing on Hemodynamics and Arrhythmia in Patients with Bradycardia-tachycardia Syndrome

Objective:To explore the effect on hemodynamics of pacing in right ventricle septum in the patients with bradycardia-tachycardia syndrome after long-term impact,and the effect on paroxysmal atrial fibrillation of pacing in right ventricle septum.Methods:Seventy-eight patients with DDD pacemarker with bradycardia-tachycardia syndrome,according to the location of ventricular electrodes were randomly divided into RVS and RVA group.Compare the QRS-wave width,left ventricular ejection fraction,left ventricular end-diastolic diameter,P wave dispersion,atrial fibrillation threshold load of pre-implantation after six and twelve months after operation.Results:Both groups were followed up after six and twelve months after operation.QRS-wave width increased after pacing in RVS group,but there was no significant difference between before and after pacing(P>0.05).Compared with preoperative,QRS-wave width significantly increased in RVA group.Cardiac function and left ventricular end-diastolic diameter were similar in RVS group.Cardiac function were significantly decreased,but left ventricular end-diastolic diameter significantly increased in RVA group.There was obvious difference between two groups(P<0.05).P wave dispersion and atrial fibrillation threshold load of pre-implantation haven't significantly change in RVS group,but obviously increased in RVA group.Conclusion:Right ventricular septal pacing is a safe and effective method.Right ventricular septal pacing will stabilize or improve the long-term cardiac function in patients with slow-quick syndrome,and minimize the onset of paroxysmal atrial fibrillation.