起搏负荷超声心动图评价右室高位室间隔起搏和右室心尖部起搏对心脏功能的影响

目的评价右室高位室间隔(HRVS)起搏和右室心尖部(RVA)起搏对心脏结构和功能的影响。方法71例病窦综合征、完全性房室传导阻滞患者根据心室起搏电极植入部位的不同,随机分为HRVS起搏组(36例)和RVA起搏组(35例)。分别于术前、术后3个月和术后12个月通过超声心动图和起搏负荷超声心动图检查对患者左室收缩和舒张末期容积(LVESV和LVEDV)、左右室射血前时间差值(LRVPEI)、室间隔与左室后壁收缩延迟时间(SPWMD)、左室射血分数(LVEF)等相关指标进行观察随访。结果术后3个月、12个月时,两组各项起搏参数均无差别。术后3个月时,HRVS起搏组的LRVPEI和SPWMD均明显小于RVA起搏组(P<0.05),两组间其他指标在基础状态超声下无显著差别,在起搏负荷超声下HRVS起搏组的LVEF明显高于RVA起搏组(P<0.05)。术后12个月时,HRVS起搏组的LRVPEI、SPWMD和LVESV三项指标均显著小于RVA起搏组(P<0.05),LVEF明显高于RVA起搏组(P<0.01);LVEDV小于RVA起搏组,但无统计学意义。结论HRVS起搏对心脏结构和功能的不良影响明显低于RVA起搏。

Effects of high right ventricular septal pacing and right ventricular apical pacing on cardiac function evaluated by pacemaker stress echocardiography

Objective To study effects of high right ventricular septal （HRVS） pacing and right ventricular apical（RVA） pacing on cardiac structure and function. Method Seventy-one patients implantend pacemaker for sick sinus syndrome or atrioventricular block were divided into two groups according to the pacing site, HRVS pacing group （36 patients） and RVA pacing group（35 patients）. LVESV, LVEDV, LRVPEI, SPWMD, LVEF were measured before pacemaker implantation and 3 and 12 months after the implantation by echecardiography and pacemaker stress echecardiography. Results No significant difference in the pacing parameters between the two groups was observed at 3 and 12 months after implantation. At 3 months after implantation, LRVPEI and SPWMD of HRVS pacing group became significantly smaller than those of RVA pacing group （P 〈 0. 05 ）, other indexes were similar in the two groups. By pacemaker stress echecardiography LVEF was higher during HRVS pacing than during RVA pacing（P 〈 0. 05 ） ; At 12 months after implantation, LRVPEI , SPWMD and LVESV were smaller and LVEF was higher in HRVS pacing group than those in RVA pacing group （ P 〈 0.05 ） ; the LVEDV was smaller in HRVS pacing group than that in RVA pacing group, but the difference was insignificant between the two groups （P 〉0.05）. Conclusions The deleterious long-term effects on cardiac structure and function is significantly less during HRVS pacing than RVA pacing.