中华心律失常学杂志
中華心律失常學雜誌
중화심률실상학잡지
CHINESE JOURNAL OF CARDIAC ARRHYTHMIAS
2009年
4期
250-252
,共3页
陈建明%沈法荣%王志军%凌锋%金红峰%何浪%钟诚%陈旭娇%汤益民%孙国建%吴巧元%郑良荣
陳建明%瀋法榮%王誌軍%凌鋒%金紅峰%何浪%鐘誠%陳旭嬌%湯益民%孫國建%吳巧元%鄭良榮
진건명%침법영%왕지군%릉봉%금홍봉%하랑%종성%진욱교%탕익민%손국건%오교원%정량영
慢性心力衰竭%心脏再同步治疗%心外膜起搏%复极离散度
慢性心力衰竭%心髒再同步治療%心外膜起搏%複極離散度
만성심력쇠갈%심장재동보치료%심외막기박%복겁리산도
Chronic heart failure%Cardiac resynchronization therapy%Epicardial pacing%Dispersion of reploarization
目的 观察心室不同位点起搏时心电图上心肌复极标志的变化,了解以双心室起搏技术为核心的心脏再同步治疗(CRT)对心肌复极离散的影响.方法 入选接受CRT植入的患者在起搏器植入后1周内记录12导联心电图,分别将起搏器程控为无起搏、右心室内膜下起搏(RV-EndoP)、左心室外膜起搏(LV-EpiP)及双心室同步起搏(BivP)四种不同状态并记录心电图.阅读不同起搏位点时的QRS时限、QT间期及TP.E时限.QTc用Bazett公式(QTc=实测QT/(RR)1/27进行矫正.结果 基线QTc为(489.2±51.2)ms,而RV-EndoP、LV-EpiP起搏导致QTc明显延长[RV-EndoP(537.3±45.7)ms,P＜0.05;LV-EpiP(592.4±60.2)ms,P＜0.001],而BivP起搏为(491.3±52.7)ms,P＞0.05;基线TP.E(113.8±15.7)ms,RV-EndoP、LV-EpiP均导致TP.E明显延长(RV-EndoP(124.8±24.7)ms,P＜0.05;LVEpi P(133.3±37.8)ms,P＜0.005],BivP时TP.E时限为(109.9±17.1)ms,有轻度缩短,但差异没有统计学意义(P＞0.05).结论 左心室外膜起搏可明显延长心肌复极离散指标;双心窒同步起搏可减少由单纯左心室外膜起搏引起的复檄离散度的增大.
目的 觀察心室不同位點起搏時心電圖上心肌複極標誌的變化,瞭解以雙心室起搏技術為覈心的心髒再同步治療(CRT)對心肌複極離散的影響.方法 入選接受CRT植入的患者在起搏器植入後1週內記錄12導聯心電圖,分彆將起搏器程控為無起搏、右心室內膜下起搏(RV-EndoP)、左心室外膜起搏(LV-EpiP)及雙心室同步起搏(BivP)四種不同狀態併記錄心電圖.閱讀不同起搏位點時的QRS時限、QT間期及TP.E時限.QTc用Bazett公式(QTc=實測QT/(RR)1/27進行矯正.結果 基線QTc為(489.2±51.2)ms,而RV-EndoP、LV-EpiP起搏導緻QTc明顯延長[RV-EndoP(537.3±45.7)ms,P＜0.05;LV-EpiP(592.4±60.2)ms,P＜0.001],而BivP起搏為(491.3±52.7)ms,P＞0.05;基線TP.E(113.8±15.7)ms,RV-EndoP、LV-EpiP均導緻TP.E明顯延長(RV-EndoP(124.8±24.7)ms,P＜0.05;LVEpi P(133.3±37.8)ms,P＜0.005],BivP時TP.E時限為(109.9±17.1)ms,有輕度縮短,但差異沒有統計學意義(P＞0.05).結論 左心室外膜起搏可明顯延長心肌複極離散指標;雙心窒同步起搏可減少由單純左心室外膜起搏引起的複檄離散度的增大.
목적 관찰심실불동위점기박시심전도상심기복겁표지적변화,료해이쌍심실기박기술위핵심적심장재동보치료(CRT)대심기복겁리산적영향.방법 입선접수CRT식입적환자재기박기식입후1주내기록12도련심전도,분별장기박기정공위무기박、우심실내막하기박(RV-EndoP)、좌심실외막기박(LV-EpiP)급쌍심실동보기박(BivP)사충불동상태병기록심전도.열독불동기박위점시적QRS시한、QT간기급TP.E시한.QTc용Bazett공식(QTc=실측QT/(RR)1/27진행교정.결과 기선QTc위(489.2±51.2)ms,이RV-EndoP、LV-EpiP기박도치QTc명현연장[RV-EndoP(537.3±45.7)ms,P＜0.05;LV-EpiP(592.4±60.2)ms,P＜0.001],이BivP기박위(491.3±52.7)ms,P＞0.05;기선TP.E(113.8±15.7)ms,RV-EndoP、LV-EpiP균도치TP.E명현연장(RV-EndoP(124.8±24.7)ms,P＜0.05;LVEpi P(133.3±37.8)ms,P＜0.005],BivP시TP.E시한위(109.9±17.1)ms,유경도축단,단차이몰유통계학의의(P＞0.05).결론 좌심실외막기박가명현연장심기복겁리산지표;쌍심질동보기박가감소유단순좌심실외막기박인기적복격리산도적증대.
Objective To investigate the characteristic of electrocardiogram pacingin different sites and the effects of cardiac resynchronization therapy(CRT)on the dispersion of the repolarization.Methods Forty patients with biventricular pacemaker were included in this study.Standard surface ECGs were recorded continuously while the pacemaker was programmed to biventricular pacing,left ventricular(LV)pacing,right ventricular (RV)pacing and no pacing mode.ECG analysis was performed by electrophysiology specialists.The parameters of repelarization dispersion included QRS duration,QT interval and TP.E duration,and OTc interval were corrected for heart rate using Baser formula.Results When baseline QTc duration was(489.2±51.2)ms,RV-EndoP and LV-EpiP pacing induced QTc increase significantly[RV-EndoP(537.3±45.7)ms,P＜0.05;LV-EpiP (592.4±60.2)ms,P＜0.001];when BivP pacing intervals was(491.3±52.7)ms,P＞0.05;when baseline TP.E was(113.8±15.7)ms,RV-EndoP and LV-EpiP caused TP.E prolonging significantly,(RV-EndoP(124.8±24.7)ms,P＜0.05;LV-Epi P(133.3±37.8)ms,P＜0.005];the duration of TP.E was(109.9±17.1)ma for biventricular pacing(P＞0.05).Conclusions Epicardial pacing of left ventricle will increase the myocardial dispersion of repelarization,however,bi-ventricular pacing could avoid such kind increase of dispersion caused by epicardial pacing of left ventricle alone.CRT didn't change ventricular dispersion of reploarization in generally.
