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|本期目录/Table of Contents|

右心室心尖部起搏和右心室间隔部起搏对起搏参数和心电图的影响(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2008年第1期
页码:
80-82，86
栏目:
临床研究
出版日期:
2008-01-20

文章信息/Info

Title:
Influence of pacing in right ventricular septum and right ventricular apex on pacing parameter and ECG
作者:
周宁1;  陈曼华1;  罗洪波1; 王琳2
1.武汉市中心医院心内科；2.华中科技大学同济医学院附属同济医院心内科, 湖北 武汉 430014
Author(s):
ZHOU Ning1;  CHEN Manhua1;  LUO Hongbo;  WANG Lin2
1.Department of Cardiology, Central Hospital of Wuhan City; 2.Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei, China
关键词:
右心室心尖部起搏; 右心室间隔部起搏; 起搏参数; 心室电同步
Keywords:
right ventricular septum pacing;  right ventricular apex pacing;  pacing parameter;  ventricular electrical synchrony
分类号:
R331.38
DOI:
-
文献标识码:
A
摘要:
目的 评估右室间隔部起搏和右室心尖部起搏对起搏参数和双心室电同步性的影响。 方法 将20例植入DDD型起搏器患者随机为分2组(每组10例)：一组患者行间隔部起搏，一组行心尖部起搏；分析两组有效起搏时及1、3个月随访时各起搏参数差异；对比术中心室电极到位所需X射线曝光时间、术中及术后并发症；比较术前自身心律心电图、术后起博心电图的QRS波宽度、形态。 结果 有效起搏时心尖部和间隔部起搏电压阈值、电极阻抗、R波高度无显著差异。电极植入后第1、3个月随访，两组起搏参数之间无显著差异，且动态变化相似；心室电极到位所需X线曝光时间：心尖部为(203 ±127)s，间隔部为(581±124 )s(P<0.01)。电极植入术中及术后均未出现并发症；术前和术后心电图Ⅱ导联QRS宽度：心尖部起搏组分别为（0.11±0.03）s、（0.19±0.02）s（P<0.05）；间隔部起搏组分别为（0.10±0.02）s、（0.12±0.02）s，术后QRS形态与术前心电图相似。术后间隔部起搏和心尖部起搏心电图的QRS波宽度对比，前者明显窄于后者(P<0.01)。 结论 右心室间隔部起搏和右心室心尖部起搏同样安全、有效，而且更符合生理性心室激动顺序，有利于双心室电激动的同步性。
Abstract:
AIM To evaluate the influence of pacing in right ventricular septum (RVS) and right ventricular apex (RVA) on pacing parameter and biventricular electrical synchrony. METHODS DDD pacing was performed in 20 patients who were grouped randomly into two groups: one group receiving RVS pacing while the other group receiving RVA pacing. The pacing parameters of RVA and RVS pacing were analyzed when the heart was paced effectively. We compared the Xray exposure time in the ventricular electrode implantation and complications between the two different pacing sites. The ECG before the implantation of electrode and the pacing ECG were recorded and analyzed. RESULTS When the ventricle was paced effectively, the pacing parameters, including voltage threshold, electrode impedance and R wave height, were similar between the two groups. The Xray exposure time in the ventricular electrode implantation of the RVA pacing group was (203±127) seconds while in the RVS pacing group it was (581±124) seconds (P<0.05). No complications were found during the implantation of electrode and in the followup. The QRS complex duration of lead Ⅱ of RVA pacing group was (0.11±0.03) seconds before the implantation of electrode while it widened statistically to (0.19±0.02) seconds after the implantation. In the RVS pacing group, the QRS duration only widened from （0.10±0.02） seconds to （0.12 ±0.02） seconds and this change had no statistic significance. The QRS duration of RVS pacing was obviously narrower than that of the RVA pacing. CONCLUSION The RVS pacing is not only as safe and effective as RVA pacing, but is also more consistent with the physiological ventricular activation sequence and beneficial to the biventricular electrical synchrony.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2006-11-06.通讯作者：陈曼华，主任医师，主要从事介入心脏病的诊治研究Email：doc.cmh@163.com 作者简介：周宁，硕士，住院医师Email：zn075@163.com
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