右室心尖部和高位室间隔起搏对完全性房室传导阻滞患者心功能的影响

目的评价右室心尖部(RVA)起搏和高位右室间隔(HRVS)起搏对完全房室传导阻滞(CAVB)患者心功能的影响。方法 118例因CAVB植入起搏器的患者,其中52例为RVA起搏(RVA组),66例为HRVS起搏(HRVS组)。分别对术前、术后6个月及术后1年、2年的左室射血分数(LVEF)和2年内因心力衰竭住院人数进行随访观察。结果所有患者均完成1年随访,101例完成2年随访。术后6个月和1年时两组LVEF比较无差别(0.55±0.08vs0.55±0.08,P=0.926;0.54±0.09vs0.55±0.07,P=0.407),但是对于术前LVEF(0.50者,术后1年时LVEF两组有差别(0.40±0.04vs0.44±0.04,P=0.01)。术后2年,HRVS组优于RVA组(0.51±0.10vs0.55±0.06,P=0.01)。2年内,RVA组因心力衰竭住院人数多于HRVS组31.1%(14/45)vs12.5%(7/56),P=0.02]。结论 HRVS起搏对CAVB患者心功能的长期影响低于RVA起搏。

Effects of right ventricular apical and high ventricular septal pacing on heart function in patients with complete atrioventricular block

Objective To study the effects of high ventricular septal （HRVS） and right ventricular apical （RVA） pacing on heart function in patients with complete atrioventricular block（CAVB）. Method One handred and eighteen patients with CAVB who received implanting pacemaker were enrolled in this study,and were divided into HRVS pacing group （n = 52）and RVA pacing group（ n = 66）. Left ventricular ejection fraction（LVEF） were measured before implantation and 6 months, one year , and two years after the implantation by echocardiography, and registered the number of hospitalization in both groups for two years. Results No significant difference of LVEF in two groups at 6 months, one year after the implantation （0.55 ± 0.08 vs 0.55 ± 0.08,P = 0.926 ;0.54 ±0.09 vs 0.55± 0.07, P = 0.407 ）. But there were significant difference after one year in patients whose LVEF were 〈 0.50 before the implantation （0.40 ± 0.04 vs 0.44 ± 0.04, P = 0.01 ）. And the LVEF level were also significantly different after two years（0.51 ±0. 10 vs 0.55 ±0.06,P =0.01 ）. There were more patients in hospital of RVA group than those in HRVS group during two years31.1% （14/45） vs 12.5% （7/56） ,P =0.02]. Conclusion The long-term effect on cardiac function in patients with CAVB is significantly worse during HRVS pacing than that during RVA pacing.