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|本期目录/Table of Contents|

右心室不同部位起搏对左心室收缩功能的影响(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2012年第1期
页码:
78-81
栏目:
临床研究
出版日期:
2012-02-25

文章信息/Info

Title:
Impact on left ventricular systolic function by long-term permanent right ventricular pacing in different sites
作者:
时向民1; 王玉堂1; 单兆亮2; 杨庭树1
(解放军总医院：1.南楼心内科，2.普通心内科，北京 100853)
Author(s):
SHI Xiang-min1;  WANG Yu-tang1;  SHAN Zhao-liang2;  YANG Ting-shu1
(1.Department of Cardiology, South Building, 2.Department of Cardiology, PLA General Hospital, Beijing 100853, China)
关键词:
起搏; 右心室心尖部; 流出道间隔部; 左室收缩功能
Keywords:
pacing;  right ventricular apex;  right ventricular septal outflow tract;  left ventricular systolic function
分类号:
R572
DOI:
-
文献标识码:
A
摘要:
目的:比较右心室心尖（RVA）及流出道间隔部（RVOT-S）起搏对左心室收缩功能的影响，探讨合理的右心室起搏部位。方法： 自2007年8月～2009年12月，36例左室收缩功能正常的完全性房室传导阻滞患者，随机纳入RVA和RVOT-S起搏组，起搏器植入12月后分别测定左室射血分数（LVEF），左室收缩末容量（LVESV），主动脉瓣口速度时间积分（VTI），主动脉与肺动脉瓣开放时间差（QAO-QP），房颤负荷（AFb），自动模式转换（AMS），血浆脑钠尿肽原（NT-proBNP）变化，QRS波宽度，比较两组的差别。结果： 起搏12月后RVOT-S组LVEF及VTI明显高于RVA组（均P<0.05）；LVESV，QAO-QP，NT-BNP，AFb，AMS及QRS波宽度明显低于RVA组（均P<0.05）。结论： 与RVOT-S组相比，RVA长期起搏可导致明显左右心室间以及左室内收缩不同步及左室重构，减低左心室收缩功能，对心室依赖起搏患者应首选RVOT-S为心室电极植入部位。
Abstract:
AIM:To compare the effects on left ventricular systolic function by long-term permanent pacing in right ventricular apex (RVA) and right ventricular outflow tract septal (RVOT-S) and to investigate the optimal right ventricular site for permanent pacing. METHODS: Thirty-six patients diagnosed as having complete atrial-ventricular block (CAVB) and normal left ventricular systolic function and who were hospitalized during the period of August 2007 to December 2009 ［male/female=20/16, mean age: (51.3±22.2) years］ were randomly assigned to RVA pacing group and RVOT-S pacing group. Twelve months after implantation of permanent pacemakers, left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), aortic velocity time integral (VTI), activation delay between aortic and pulmonary artery valve (QAO-QP), atrial fibrillation burden (AFb), automatic mode switch (AMS), serum NT-Pro-BNP (NT-proBNP) and width of QRS were analyzed and compared between groups. RESULTS: After 12 months pacing, LVEF and VTI in RVOT-S group were significant higher than those in RVA group (P<0.05). LVESV, QAO-QP, AFb, AMS, N-BNP and QRS width in RVOT-S group were statistically lower than those in RVA group (P<0.05). CONCLUSION: Long-term RVA pacing could induce inter- and intraventricular desynchrony and left ventricular remodeling, which would impair the left ventricular systolic function. RVOT-S could be the optimal site for permanent ventricular pacing.

参考文献/References

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[2] Leong DP,Mitchell AM,Salna I,et al.Long-term mechanical consequences of permanent right ventricular pacing: Effect of pacing site[J].J Cardiovasc Electrophysiol,2010,21(10):1120-1126.

[3]Sweeney MO,Hellkamp AS.Heart failure during cardiac pacing[J].Circulation,2006, 113(17):2082-20888.

[4]Bleeker GB,Mollema SA,Holman ER,et al.Left ventricular resynchronization is mandatory for response to cardiac resynchronization therapy: analysis in patients with echocardiographic evidence of left ventricular dyssynchrony at baseline[J]. Circulation,2007,116(13):1440-1448.

[5]Yu CM,Bleeker GB,Fung JW,et al.Left ventricular reverse remodeling but not clinical improvement predicts long-term survival after cardiac resynchronization therapy[J].Circulation,2005,112(11):1580-1586.

[6]Lin JM,Lai LP,Lin CS,et al.Left ventricular extracellular matrix remodeling in dogs with right ventricular apical pacing[J].J Cardiovasc Electrophysiol,2010,21(10):1142-1149.

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[8]Sweeney MO,Bank AJ,Nsah E,et al.Minimizing ventricular pacing to reduce atrial fibrillation in sinus-node disease[J].N Engl J Med,2007,357(10):1000-1008.

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备注/Memo

备注/Memo:
收稿日期：2011-07-25.通讯作者：王玉堂，主任医师，主要从事心脏电生理基础与临床研究 Email：wyt301@sina.com 作者简介：时向民，副主任医师，博士 Email:shixm301cardiac@hotmail.com
更新日期/Last Update: 2012-02-14