右心室高位间隔部与心尖部起搏对心功能影响的比较

目的:对比右心室高位间隔部起搏(right high-interventricularseptum,RHIVS)与右心室心尖部(right ventricular apex,RVA)起搏对心功能的影响。方法:选取60例植入起搏器的患者,随机分为2组,30例行右心室高位间隔部起搏为RHIVS组,30例行右心室心尖部起搏为RVA组。比较两组术前及术后12个月的6分钟步行试验,术前及术后3个月、6个月、12个月的左室射血分数(left ventricular eject fraction,LVEF)。结果:RHIVS组与RVA组术前6分钟步行试验(six minute corridorwalktest,6-MWT)步行距离及LVEF无统计学差异。术后12个月,RVA组6-MWT步行距离较RHIVS组明显降低(310±95vs 415±103,P0.01)。术后3个月、6个月及12个月,RVA组LVEF亦较RHIVS组有显著的减低(53.47±3.95 vs 56.25±4.73,P0.05;52.17±3.68 vs 55.10±4.47,P0.05;46.97±2.59 vs 53.95±4.84,P0.01)。结论:右心室高位间隔部起搏防止起搏导致的心功能的恶化,改善患者的生活质量,更接近生理性起搏。

Comparison of Effects on Cardiac Function between Pacing in Right High-interventricular Septum (RHIVS) and Right Ventricular Apex(RVA)

Objective To evaluate the cardiac function between RHIVS pacing and RVA pacing.Methods 60 patients with indications of pacing were divided into two groups randomly.Group A including 30 patients received RHIVS pacing while group B（30 cases） received RVA pacing.The distance of six minute corridor walk test（6-MWT） was compared before and 12 months after operation in both groups.The left ventricular eject fraction（LVEF） was also measured in two groups before and 3 months,6 months,12 months after operation.Results There was no significently differnce between two groups on the distance of 6-MWT and LVEF before operation.The distance of 6-MWT in RVA group was shorter than that in RHIVS group after 12 months operation（310±95 vs 415±103,P0.01）.LVEF was less decreased in RHIVS group than that in RVA group after 3 months,6 months,12 months operation（56.25±4.73 vs 53.47±3.95,P0.05;55.10±4.47 vs 52.17±3.68,P0.05;53.95±4.84 vs 46.97±2.59,P0.01）.Conclusions The RHIVS pacing can prevent deterioration of cardiac function and improve the quality of living after operation.Therefore,RHIVS pacing is more appropriate physiologic pacing.