CAJ | 학술논문

目的应用组织多普勒方法随机对照研究右心室流出道间隔部(right ventricular outflow tract septum,RVOTS)起搏与右心事心尖部(right ventricular apical,RVA)起搏心脏同步性和心功能变化,探讨右心室流出道间隔部在生理性起搏中的临床意义.方法 128例缓慢心律失常患者按单双数字随机分为两组,对病态窦房结综合征房窒功能正常患者,起搏器植入术后根据心电图PR间期时间将起搏器AV间期调整,暂时关闭AV搜索功能以保证心室起搏.所有患者起搏器植入术后1、3、6个月定期随访,观察起搏参数、累积心室起搏百分比,同时行超声心动图检查.结果 RVOTS起搏组与RVA起搏组电极导线植入时间、X线曝光时间差异有统计学意义(P＜0.01),主动固定电极导线植入15 min与植入即刻比较起搏阚值明显下降,分别为(0.76±0.21)mV和(1.13±0.25)mV(P＜0.01).RVOTS起搏组和RVA起搏组QRS时限分别为(0.14±0.04)s、(0.16±0.03)s(P＜0.01).随访6个月起搏参数两组之间差异无统计学意义.全部患者未出现植入并发症,随访6个月无电极导线移位、阈值增高.6个月RVOTS起搏组左心室同步指标明显优于RVA起搏组(P＜0.01).左心室收缩末内径及舒张末内径两组比较无显著变化,左心室射血分数在RVA起搏组有所降低(P＜0.05),心脏做功指数(Tei)、RVOTS起搏组与RVA起搏组比较差异有统计学意义(P＜0.05),在RVA起搏组随访6个月与1个月比较差异有统计学意义(P＜0.01).结论 RVA起搏导致心脏收缩不同步,损害左心室功能.RVOTS起搏保持良好心脏收缩同步性、保护左心室功能,是较好的右心室起搏部位.
목적 응용조직다보륵방법수궤대조연구우심실류출도간격부(right ventricular outflow tract septum,RVOTS)기박여우심사심첨부(right ventricular apical,RVA)기박심장동보성화심공능변화,탐토우심실류출도간격부재생이성기박중적림상의의.방법 128례완만심률실상환자안단쌍수자수궤분위량조,대병태두방결종합정방질공능정상환자,기박기식입술후근거심전도PR간기시간장기박기AV간기조정,잠시관폐AV수색공능이보증심실기박.소유환자기박기식입술후1、3、6개월정기수방,관찰기박삼수、루적심실기박백분비,동시행초성심동도검사.결과 RVOTS기박조여RVA기박조전겁도선식입시간、X선폭광시간차이유통계학의의(P＜0.01),주동고정전겁도선식입15 min여식입즉각비교기박감치명현하강,분별위(0.76±0.21)mV화(1.13±0.25)mV(P＜0.01).RVOTS기박조화RVA기박조QRS시한분별위(0.14±0.04)s、(0.16±0.03)s(P＜0.01).수방6개월기박삼수량조지간차이무통계학의의.전부환자미출현식입병발증,수방6개월무전겁도선이위、역치증고.6개월RVOTS기박조좌심실동보지표명현우우RVA기박조(P＜0.01).좌심실수축말내경급서장말내경량조비교무현저변화,좌심실사혈분수재RVA기박조유소강저(P＜0.05),심장주공지수(Tei)、RVOTS기박조여RVA기박조비교차이유통계학의의(P＜0.05),재RVA기박조수방6개월여1개월비교차이유통계학의의(P＜0.01).결론 RVA기박도치심장수축불동보,손해좌심실공능.RVOTS기박보지량호심장수축동보성、보호좌심실공능,시교호적우심실기박부위.
Objective To compare the effects of right ventrieular outflow tract septum(RVOTS)pacing and right ventricular apex(RVA)pacing on left ventricular synchronization and cardiac function by tissue Doppler image.Methods One hundred and twenty-eight patients with bradyarrhythmia were randomly divided into two groups(RVOTS group and RVA group).In the sinus sick syndrome patients with normal atrial-ventricle conduction,AV durations were prolonged according to PR duration of ECG and close AV search function in order to ensure ventricalar pacing after implantation.All patients were regudarly followed up on clinic 1st month,3rd month and 6th month after pacemaker implantation,including pacing parameter,accumulative ventricular pacing percentage and echocardiogranL Results The duration of electrode implantation and duration of Xray exposure in ROVTS group and RVA group were significantly different respectively(P＜0.01).Pacing threshold after active fixed electrodes decreased compared with that at time of implantation(1.13±0.25)mV vs.(0.76±0.21)mV,(P＜0.01).QRS durations in RVOTS group and RVA group were(0.14±0.04)s and(0.16±0.03)s(P＜0.01).There were no differences in pacing parameter between the two groups in 6 months follow-up.All patients had not suffered from implantation complications and there were also no electrodes displacement and increasing of pacing threshold.After 6 months,left ventricular synchronization parameters behaved better in RVOTS groups than those in RVA groups(P＜0.01);LVEDD and LVESD manifested no significant change(P＞0.05);LVEF significantly decreased in the RVA group(P＜0.05);Tei index was significantly different between RVOTS and RVA group.(P＜0.05).In RVA group,Tei index changed significantly on 6th months than those on 1st month(P＜0.01).Conclusions RVA pacing results in ventficular resynchronization and left ventricular function impairment.RVOTS pacing is a better pacing site with no adverse influence on ventricular synchronization and cardiac function.