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《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:

2010年第4期

页码:

581-583

栏目:

临床研究

出版日期:

2010-06-10

文章信息/Info

Title:

A comparative study between right ventricular septum pacing and right ventricular apex pacing

作者:

冯霞¹; 崔俊玉²

1.北京市健宫医院心内科，北京 100054；2.北京军区总医院心内科，北京 100700

Author(s):

FENG Xia¹;  CUI Jun-yu²

1.Department of Cardiology, Beijing Health Palace Hospital, Beijing, 100054,China; 2.Department of Cardiology, Military General Hospital of Beijing, PLA, Beijing 100700, China

关键词:

心脏起搏; 主动固定电极; 右室间隔部起搏; 右室心尖部起搏; 血流动力学

Keywords:

cardiac pacing;  active fixation lead;  right ventricular septal pacing;  right ventricular apical pacing;  hemodynamics

分类号:

R318.11

DOI:

-

文献标识码:

A

摘要:

目的: 评价右室间隔部（RVS）起搏的稳定性及对比RVS起搏和右室心尖部（RVA）对血流动力学影响。方法: 22例植入DDD起搏器患者，分为RVS组和RVA组，比较两组术中及术后起搏参数及血流动力学参数变化。结果: RVS组术中测试起搏阈值及电流均高于RVA组，术后1个月差异无统计学意义；RVS组QRS波群宽度较RVA组小（P<0.05）；RVS组X线曝光时间较RVA组长（P<0.05）；术中阻抗及R波振幅无显著差异。术后6个月，RVS组左室射血分数（LVEF）、心脏指数（CI）、每搏量（SV）、二尖瓣血流E峰和A峰最大充盈速度比值（E/A）较RVA组明显提高，术前两组无明显差异。结论: RVS起搏安全、有效，RVS起搏血流动力学参数明显优于RVA组。

Abstract:

AIM: To evaluate the stability of the application of active fixation leads with right ventricular septum (RVS) pacing and to compare the hemodynamic effects of RVS pacing and right ventricular apex pacing (RVA) in patients with implanted DDD pacemakers. METHODS: There were 22 patients with implanted DDD pacemakers who were randomly divided into RVS group and RVA group. RESULTS: Impedance and amplitude of R-wave were similar during implantation between groups. The pacing threshold and electric current were significantly higher in RVS group than in RVA group; however, these differences disappeared at 1 month post-pacemaker implantation. Mean QRS duration was shorter in RVS group than in RVA group (P<0.05). RVS group had longer X-ray exposure than RVA group (P<0.05). Left ventricular ejection fraction (LVEF), cardiac index (CI), stroke volume (SV), and mitral E/A ratio (E/A) were higher in RVS group than in RVA group at 6 months post-pacemaker implantation, but there were no preoperative differences. CONCLUSION: Pacing at right ventricular outflow was safe and efficient. RVS pacing was more effective according to hemodynamic effects than RVA pacing.

参考文献/References

［1］王方正,陈若茜. 关于生理性起搏的几个大型临床试验［J］. 中华心律失常学杂志, 2007, 11（5）:328-330.

［2］郭继鸿. 生理性起搏及临床应用［J］. 心血管病学进展, 2006, 27（2）:144-148.

［3］ 陈泗林,林纯莹,刘烈,等. 主动固定电极在右室流出道间隔部起搏的临床应用［J］. 中国心脏起搏与心电生理杂志, 2007, 21(3):206.

［4］Lieberman R, Grenz D, Mond HG, et al. Selective site pacing: defining and reaching the selected site［J］. Pacing Clin Electrophysiol, 2004, 27（6 Pt 2）:883-886.

［5］Buckingham TA, Candinas R, Attenhofer C, et al. Systolic and diastolic function with alternate and combined site pacing in the right ventricle［J］. Pacing Clin Electrophysiol, 1998, 21(5):1077-1084.

［6］Victor F, Mabo P, Mansour H, et al. A randomized comparision of permanent septal versus apical right ventricular pacing:short-term results［J］. J Cardiovasc Electrophysiol, 2006, 17（3）:238-242.

备注/Memo

备注/Memo:

收稿日期：2009-02-06.作者简介：冯霞，主治医师，硕士Emal:fxace@163.com

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更新日期/Last Update: 2010-05-20