右心室不同间隔部位起搏对左心室收缩功能的影响

目的 通过比较右心室心尖部及不同间隔部位（室间隔高位、中位、低位）起搏患者血浆N端B型利钠肽前体（NT-proBNP）水平、QRS时限,探讨右心室不同部位起搏对左心室收缩功能的影响.方法 选择植入VVI或DDD型起搏器患者122例,按照右心室不同起搏部位采用随机数字法分为4组：右心室心尖部起搏（RVAP）组、右心室间隔面起搏高位组（RVSP1组）、右心室间隔面起搏中位组（RVSP2组）、右心室间隔面起搏低位组（RVSP3组）,观察4组患者起搏器植入术前及术后18个月心电图QRS时限、血浆NT-proBNP水平、左心室射血分数（LVEF）、左心室舒张末期容积（LVEDV）以及出现心血管事件等指标.结果 所有患者均顺利完成导线和起搏器植入,并完成随访.心血管事件发生率比较,RVSP2组较RVAP组显著减低（4.5％对40％,P＜0.05）.术后RVAP组QRS时限最宽,RVSP2组起搏QRS时限最窄,差异有统计学意义（P＜0.05）;术后18个月患者RVAP、RVSP1、RVSP3组NTproBNP均有不同程度增加,其中RVAP组最高（P＜0.05）;4组患者LVEDV术后18个月与术前比较,RVSP3组与RVAP组有不同程度增加（P＜0.05）,其中RVAP组增加显著（P＜0.05）;术后18个月RVSP组LVEF均无显著减低（P＞0.05）,而RVAP组显著减低（P＜0.05）.结论 选择右心室中位间隔部起搏,起搏QRS时限最窄,患者NT-proBNP水平低,可能为起搏器植入患者理想的起搏部位.

Effects of different septal pacing of right ventricle on left ventricular systolic function

Objective To evaluate the effect of different right ventricular septal pacing on the left ventricular systolic function by comparing plasma NT-proBNP levels and QRS wave duration.Methods One hundred and twenty-two patients with implanted DDD pacemaker,in accordance with the right ventricular different pacing sites were randomly divided into four groups：right ventricular apex pacing,right ventricular septal pacing high group （group RVSP1）,group of right ventricular septal pacing in median （group RVSP2）,right ventricular septal pacing low surface group （group RVSP3）.ECG QRS wave duration,levels of plasma NT-proBNP,left ventricular ejection fraction （LVEF） and left ventricular end diastolic diameter （LVEDV）,cardiovascular events were recorded and compared before and 18 months after pacemaker implantation.Results All patients were successfully completed the implantation of conductor and followed up.The incidence rate of cardiovascular events was highest in RVAP group,lowest in RVSP2 group,and the difference was statistically significant.Among the four groups,the QRS wave duration was the most widest in RVAP,while the QRS wave duration was the narrowest in RVSP2 group （P〈 0.05）.Plasma NT-proBNP levels were,increased in RVAP、RVSP1、RVSP3,the RVAP was the largest.Among the four groups the LVEDV were increased in RVSP3 and RVAP compared before and 18 months after pacemaker implantation （P 〈 0.05）.LVEF were no changes in RVSP groups（P〉0.05）,but decreased in RVAP at 18 months after pacemaker implantation（P〈0.05）.Conclusion The right ventricular septal pacing in median had the narrow QRS wave duration with NT-proBNP cardiovascular events decreased.May be the pacing site ideal for patients.