永久性起搏器植入对左室重塑影响的研究

目的通过分析植入人工永久性心脏起搏器患者的左心室形态及心功能变化,比较不同起搏方式及不同起搏比例对左室重塑的影响。方法选择50例起搏器植入患者(VVI组25例、DDD组25例)随访观察比较术前术后LVDD、LVSD、LVEF变化;随访时记录24小时动态心电图,比较不同起搏比例对术后LVDD、LVSD、LVEF的影响。结果VVI型起搏器植入前后比较LVDD和LVSD显著增大(P<0.01),而LVEF显著下降(P<0.01);DDD型起搏器植入前后LVDD、LVSD比较无明显变化,而LVEF有下降趋势;起搏比例较高组术后LVDD及LVSD较起搏比例较低组增大,LVEF较起搏较低组降低。结论植入永久起搏器可诱发左心室重塑的发生,以VVI型起搏器明显,故接近生理性起搏模式的DDD起搏优于VVI起搏;同时,在不影响心脏搏动功能的前提下,应尽量减少起搏比例,能减轻心脏重塑。

Effects of Permanent Pacemaker Implantation on Left Ventricular Remodeling

Objective To assess characteristics of structural remodeling of left ventricle after pacemaker implantation.To compare characteristics of structural remodeling of left ventricle between differ mode and ratio of heart beats by pacemaker.Methods The left ventricular diastolic dimension（LVDD）,left ventricular systolic dimension（LVSD）,left ventricular ejection fraction（LVEF） were collected by Doppler echocardiogram before pacemaker implantation and after implantation in 50 patients.VVI pacemaker was implanted in 25 patients,and DDD pacemaker was impanted in 25 patients.Followed-up record 24-hour Holter monitoring,comparison of different pacing frequency effect on postoperative LVDD,LVSD and LVEF.Results LVDD LVSD increased and LVEF descend comparison before and after VVI implantation.LVDD,LVSD comparison before and after of DDD pacemaker implantation without obvious changes,and LVEF have a downward trend;LVDD LVSD increased and LVEF descend comparison Pacing the higher frequency group and the lower group.Conclusion Permanent pacemaker implantation induced left ventricular remodeling,VVI pacemaker obvious,so close to physiological pacing modes of DDD pacing than VVI pacing,while,on the premise of does not affect the heart beat feature,Should minimize its pacing,reducing cardiac remodeling.