我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

右心室流出道间隔部起搏对完全性房室传导阻滞患者心功能的影响

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2013年第5期
页码:
558-560
栏目:
临床研究
出版日期:
2013-09-25

文章信息/Info

Title:
Effects of right ventricular outflow septal pacing on cardiac functions in patients with complete atrioventricular block
作者:
邵 山; 王小青; 钱 波; 孙建辉
(常州市第一人民医院心内科，江苏 常州 213003)
Author(s):
SHAO Shan;  WANG Xiao qing;  QIAN Bo;  SUN Jian hui
(Department of Cardiology, Changzhou First People’s Hospital, Changzhou 213000, Jiangsu, China)
关键词:
右室流出道间隔部; 右室心尖部; 起搏; 心功能
Keywords:
right ventricular outflow tract pacing;  right ventricular apex;  pacing;  cardiac function
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的:比较右心室流出道间隔部(RVS)起搏与右心室心尖部（RVA）起搏对左右心室间收缩同步性、左室重构及心功能的影响。方法： ①入选Ⅲ度房室传导阻滞患者61（男39，女22）例，随机分入RVS部起搏组（RVS组，n=33）和RVA部起搏组（RVA组，n=28）。②比较两组患者植入术中及术后12月心室电极导线参数（起搏阈值、R波感知及阻抗）的差异。③观察两组患者术前及术后12月QRS波时限；术后应用组织多普勒同步图（TSI）分别测定两组左、右心室侧壁基底部收缩达峰时间差（ΔTs）。评价心室间不同步的程度。④行多普勒超声心动图（UCG）检查，观察两组术前及术后12月左室舒张末期内径（LVEDD）及左室射血分数（LVEF）的变化，比较不同起搏部位对心功能的影响。结果： ①两组患者测试的起搏阈值、R波感知及导线阻抗无统计学差异。②两组患者术后QRS波时限均较术前延长（均P<001），RVA组较RVS组延长更为明显（P<001）。RVS组与RVA组ΔTs分别为(27±14) ms和(90±22) ms，有统计学差异(P<001)。③术后12亇月两组LVEDD均较术前增加，RVA明显大于RVS组［(54±5) mm vs.(51±5) mm，P<005］。 RVA组术后12月LVEDD较术前明显增加［(54±5) mm vs.(50±4) mm，P<005］，术后12月两组LVEF均较术前降低［RVS组：(058±014) vs.(063±009),P<001； RVA组：(051±012) vs.(064±013)，P<001］，组间比差异不显著。结论： RVS起搏对心室间同步性、左室重构的影响要优于RVA起搏。
Abstract:
AIM:To compare the effect of right ventricular outflow tract septum (RVS) pacing and right ventricular apical (RVA) pacing on contraction synchrony, ventricular remodeling and cardiac functions. METHODS: Sixtyone patients (39 males, 22 females) with III atrium ventricular conduction block (AVB) were randomly divided into RVS group (n=33) and RVA group (n=28). The parameters of the pacing leads on implantation and postimplantation and changes of QRS duration of pre and postimplantation were observed. The ventricular synchrony was evaluated by tissue Doppler and left ventricular enddiastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) were compared between groups. RESULTS: No statistical differences were observed in the pacing parameters between groups (P>005). Postimplantation QRS duration was significantly prolonged in both groups (P<001), especially in the RVA group (P<001). Ts (time to peak systolic velocity) of the left lateral wall to the right wall was (27±14) ms for RVS pacing and (90±22) ms for RVA pacing (P<001). LVEDD of postimplantation significantly increased compared with preimplantation in RVA group ［(54±5) mm vs. (50±4) mm, P<0.05］. LVEF statistically decreased in both groups ［RVS: (0.58±0.14) vs. (0.63±0.09), P<0.01; RVA: (0.51±0.12) vs. (0.64±0.13), P<0.01］. CONCLUSION: RVS pacing achieves a better effect on cardiac contraction synchrony and ventricular remodeling than RVA pacing.

参考文献/References

[1]Nielsen JC,Andersen HR,Thomsen PE,et al.Heart failure and echocardiographic changes during long term followup of patients with sick sinus syndrome randomized to singlwchamber atrial or ventricular pacing[J].Circulation,1998,97(9):987-995.
[2]Sweeney MO,Hellkamp AS,Ellenbogen KA,et al.Adverse effect of ventricular pacing on heart failure and atrial fibrillation among pateents with normal baseline QRS duration in a clinical trial of pacemaker therapy fou sinus node dysfunction[J].Circulation,2003,107(10):2932-2937.
[3]Andersen HR,Thuesen L,Bagger JP,et al.Prospective trial of atrial versus ventricular pacing in sick sinus synduome[J].Lancet,1994,344(5):1523-1528.
[4]Andersen HR,Nielsen JC,Thomsen PE,et al.Longterm followup of patients from a randomised trial of atrial versus ventricular pacing for sick sinus sundrome[J].Lancet,1997,350(6):1210-1216.
[5]Victor F,Leclercq C,Mabo P,et al.Optimal right ventricular pacing site in chronically implanted patients: a prospective randomized crossover comparison of apical and outflow tract pacing[J].J Am coll Cardiol,1999,33(8):311.
[6]Victor F,Mabo P,Mansour H,et al.A randomized comparison of permanent septal versus apical right ventricular pacing: shortterm results [J].J Cardiorasc Electrophysiol,2006,17 (7):238.
[7]史浩颖,汪 芳,孟伟栋,等.组织多普勒评价右室不同部位起搏对左室收缩功能和同步性的影响[J].中华心血管病杂志,2008,33(8):1002.
[8]Schwaab B,Frohlig G,Alexander C,et al.Influence of right ventricular stimulation site on left ventricular function in atrial asynchronous ventricular pacing[J].J Am Coll Cardiol,1999,33(6):317-323.

备注/Memo

备注/Memo:
收稿日期：2013-04-07.作者简介：邵山，副主任医师 Email：shaoshan686@163.com
更新日期/Last Update: 2013-09-30