心脏永久性起搏器的不同起搏部位对植入患者心功能的影响

目的分析右室心尖部(RVA)、右室流出道间隔(RVOTs)两种不同起搏部位对心脏永久性起搏器植入患者心功能的影响。方法 2017年6月-2018年12月我院心血管内科150例进行永久性心脏起搏器植入的患者根据不同起搏部位分为A组(68例,植入部位为RVA)、B组(82例,植入部位为RVOTs)。起搏器植入前后获取左室射血分数(LVEF)、左房射血分数(LAEF)及血浆脑钠肽(BNP)监测数据,并统计不良事件发生率。结果 A组植入后3、6个月及B组植入后1、3、6个月LVEF、LAEF依次明显升高(P<0.05),A组、B组在植入后3、6个月血浆BNP水平依次明显下降(P<0.05);而植入后1、3、6个月B组LVEF、LAEF明显高于A组,血浆BNP水平明显低于A组(P<0.05)。植入后随访6个月内,A组、B组均有房颤、心力衰竭及全因死亡病例出现,但发生率均无明显差异(P>0.05)。结论与RVA比较,RVOTs起搏更有助于左室、左房射血功能恢复,对心功能的影响更小,更适合作为首选起搏点。

The Effect of Different Pacing Sites of Permanent Pacemaker on the Cardiac Function of Implanted Patients

Objective To analyze the effects of the two pacing positions [right ventricular apex(RVA), right ventricular outflow tracts(RVOTs)] on cardiac function in patients undergoing permanent cardiac pacemaker implantation. Methods During the period from June 2017 to December 2018, there were 150 patients undergoing permanent cardiac pacemaker implantationin CadiovascularDepartment ofXinyang Central Hospital, and all of them were divided into group A(68 cases, implantation position located at RVA) andgroup B(82 cases, implantation positionlocated at RVOTs) according to different pacing positions. Before and after pacemaker implantation, monitoring data such as left ventricular ejection fraction(LVEF), left atrial ejection fraction(LAEF) and plasma brain natriuretic peptide(BNP) were obtained.The incidence of adverse events was statistically analyzed. Results LVEF and LAEF were significantly increased in turn in group A at 3 and 6 months after implantation, and in group B at 1, 3, and 6 months after implantation(P<0.05). At 3 and 6 after implantation in group A and group B, plasma BNP level was significantly decreased in tum(P<0.05). At 1, 3, and 6 months after implantation, LVEF and LAEF in group B were significantly higher than those in group A, while plasma BNP level was significantly lower than that in group A(P<0.05). Within 6 months of follow-up after implantation, there were cases with atrial fibrillation, heart failure and all-cause death both in group A and group B. There was no significant difference in incidence(P>0.05). Conclusion Compared with RVA, RVOTs pacing is more conducive to recovery of left ventricular and left atrial ejection function, withfewer influences on cardiac function, which is more suitable as the preferred pacing point.