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心房颤动患者右心室流出道间隔部起搏的可行性与安全性的观察(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2011年第4期
页码:
475
栏目:
临床研究
出版日期:
2011-08-25

文章信息/Info

Title:
Clinical study of feasibility and safety of right ventricular outflow tract septum pacing in patients with atrial fibrillation
作者:
鲜玉琼; 郑昌柱; 金环; 汪卫东; 施倩; 徐迎辉; 王玉华
上海市第七人民医院心内科，上海 200137
Author(s):
XIAN Yu-qiong;  ZHEN Chang-zhu;  JIN Huan;  WANG Wei-dong;  SHI Qian;  XU Ying-hui;  WANG Yu-hua
Department of Cardiology, Seventh People’s Hospital of Shanghai, Shanghai 200137, China
关键词:
右心室流出道间隔部; 起搏; 主动固定电极; 可行性; 安全性; 心室电同步性
Keywords:
right ventricular outflow tract septum;  pacing;  active fixation;  feasibility;  safety;  electrical synchronization of ventricular activation
分类号:
R541.71
DOI:
61-1268/R.20110503.1519.014
文献标识码:
A
摘要:
目的:通过右心室流出道间隔部（RVOTS）起搏与右心室心尖部(RVA)起搏的比较，评价RVOTS起搏的临床可行性与安全性。方法： 选择慢性心房颤动（房颤）伴长R-R间歇或缓慢心室率需植入永久起搏器患者68例，随机分配到RVOTS组（n=34）和RVA组（n=34），RVOTS组将螺旋电极导线主动固定于RVOTS，RVA组将传统的翼状电极被动固定于右心室心尖部。分别记录每例患者术中X线曝光时间；术中及术后15 min、1、6、12个月时电极导线测试参数以及是否有并发症发生；测量自身及术后起搏心电图的QRS时限。结果： RVOTS组术中X线曝光时间 (12.8±5.4)min较RVA组（9.5±2.1）min长（P<0.01），但随着手术熟练程度的增加，RVOTS组X线曝光时间逐渐缩短并接近RVA组；RVOTS组电极导线植入即刻起搏阈值与RVA组无统计学差异，导线植入15 min后及术后1、6、12个月时两组间起搏阈值无统计学差异；两组间R波振幅及阻抗在术中及术后各时期均无统计学差异；RVOTS组起搏心电图的QRS时限较RVA组显著缩短［(146±16)ms vs. (155±13)ms，P<0.05］；术中及随访期内无电极脱位、阈值增高、心肌穿孔及心包压塞等并发症。结论: 使用主动固定电极导线进行RVOTS起搏安全可行，且心室激动的电同步性优于RVA组。
Abstract:
AIM:To evaluate the feasibility and safety of right ventricular outflow tract septum (RVOTS) pacing by comparing the results of RVOTS pacing and right ventricular apex (RVA) pacing. METHODS: Sixty-eight patients with chronic atrial fibrillation and long R-R interval or slow ventricular rate, who were to be implanted with permanent VVI pacemaker, were assigned randomly to two groups: RVOTS pacing group (n=34) and RVA pacing group (n=34). A spiral active fixed lead was implanted in RVOTS whereas a wing-shaped passive fixed lead was implanted in RVA. X-ray exposure time was recorded during the operation and lead parameters and complications were recorded during the operation and 15 min after lead implant and 1, 6 and 12 months after operation. QRS duration was measured in intrinsic rhythm and pacing using electrocardiogram. RESULTS: X-ray exposure time during operation was longer (P=0.01) in RVOTS group (12.8±5.4) than in RVA group (9.5±2.1), but with increased surgical proficiency, X-ray exposure time in RVOTS group was gradually reduced and was close to that in RVA group. The immediate pacing threshold of lead in RVOTS group was higher than in RVA group (0.67±0.40 vs. 0.52±0.18) but no significant difference was observed between groups. Pacing threshold was not statistically significant 15 min after lead or 1, 6 and 12 months after operation between groups. The R wave amplitude and impedance in the two groups were not statistically significant in each period during and after operation. QRS duration of pacing was prolonged significantly (P<0.01) as compared with that of intrinsic rhythm in the two groups, but QRS duration of RVOTS pacing was significantly shorter (P<0.05) than RVA pacing. During intraoperative and follow-up periods, no complications such as electrode dislocation, threshold increase, myocardial perforation, or cardiac tamponade were observed. CONCLUSION: RVOTS pacing with active fixed lead is safe and feasible and the electrical synchronization of ventricular activation is better than that of RVA.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2010-09-30.基金项目：上海市浦东新区卫生系统重点学科建设项目基金资助(PWZXK2007-15) 通讯作者：郑昌柱，副主任医师，主要从事心肌缺血/再灌注和生理性起搏研究Email:lwqzcz@yahoo.com.cn 作者简介：鲜玉琼，副主任医师，硕士Email:xyqmender@126.com
更新日期/Last Update: 2011-06-02