右心室不同位点起搏对起搏依赖性患者血BNP的影响

目的比较右心室间隔部起搏与右心室心尖部起搏对起搏依赖性患者血BNP(脑钠肽)的影响。方法36例慢室率房颤伴高度或Ⅲ度房室传导阻滞,16例窦律伴Ⅲ度房室传导阻滞,20例显著窦性心动过缓,共72例患者,均植入VVI型心脏起搏器,按心室电极固定部位不同随机分为右心室间隔部起搏组(RVS组)和右心室心尖部起搏组(RVA组),观察2组术前与术后心电图QRS波宽度和形态;比较2组术前与术后血BNP(脑钠肽)变化。结果RVA组起搏心电图Ⅱ导联QRS间期显著长于RVS组(0.20±0.03]s vs0.12±0.04]s,P<0.01),术前2组BNP水平差异无统计学意义,术后3个月随访检测BNP,RVA组较RVS组有显著升高(121.8±5.2]pg/ml vs57.1±6.6]pg/ml,P<0.01)。结论RVA起搏扰乱了双心室电同步,恶化了血流动力学和心功能,RVS起搏尽可能的维持了双心室激动顺序和双心室收缩同步性,对血流动力学影响较小,RVS起搏是比RVA起搏更加符合生理的起搏方式。

Effect of Pacemaker at Different site of right Ventricle on Plasma Levels of Brain Natriuretic Peptide(BNP)in Patients Depending on Pacemaker

Objective To compare the effect of pacemaker at fight ventricular septum and at right ventricular apex on plasma BNP levels in patients who are dependent on pacemaker. Methods 36 patients with chronic atrial fibrillation with highdegree or complete atrioventricular block, 16 patients with sinus rhythm and completely atrioventricular block, and 20 patients with obvious sinus bradycardia, amounting to seventy-two patients performed with VVI pacemaker were grouped randomly into two terms according to the site where the pacemaker lead was fixed, one group received right ventricular septum（RVS） pacemaker while the other group received right ventricular apex（RVA） pacemaker. The QRS waves were recorded and analyzed before and after operation for each patient. Plasma BNP level was compared before and after operation. Results The QRS duration of lead Ⅱ in RVA group was longer than in RVS group dramatically（0.20 ± 0.03]s vs 0.12 ± 0.04]s, P 〈 0.01）. There was no difference on plasma BNP of the two groups before operation（ P 〉 0.05）. 3 months after operation, plasma BNP in two groups was significantly increased （ P 〈 0.05 ± 0.01 ）, it increased more in RVA group than in RVS group（ 121.8 ± 5.21 pg/ml vs 57.1± 6.6 ] pg/ml, P 〈 0.01 ）. Conclusions The RVA pacemaker disturbs the biventricular electrical synchrony and results in the deterioration of the hemodynamies and cardiac function. The RVS pacemaker farthest keeps the normal sequence of electrical activity and the synchronous contraction and has less negative effect on the hemodynamics. Therefore RVS pacemaker is more physiological than RVA pacemaker.