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目的探讨优化房室间期(AVD)起搏对病态窦房结综合征(SSS)合并心功能不全患者心功能的影响。方法入选54例SSS患者,心功能为Ⅱ～Ⅲ级,左室射血分数(LVEF)35%～50%。根据体表心电图最长PR间期,将植入永久起搏器术后的感知房室间期(SAVD)分别设置为200ms组(26例,A组)、240ms组(13例,B组)及280ms组(15例,C组)。术后平均随访时间(2.2±1.1)年,并行起搏器程控检查及心脏彩超检查。结果三组心室起搏比例分别为(19.3±4.4)%、(18.4±5.2)%以及(20.3±4.8)%(P>0.05)。术前和术后随访中三组间左房内径(LAD)及LVEF均无统计学差异(P>0.05);与术前相比,术后半年及之后三组左室舒张末期内径(LVEDD)均明显增大,B、C组LVEDD明显大于A组(P<0.05)。结论 SSS合并心功能不全患者植入永久起搏器后,SAVD程控为200ms对心功能影响最小;过度延长SAVD可导致LVEDD明显增加,损伤心功能。
Objective To investigate the effect of optimal AVD pacing on cardiac function in patients with sick sinus syndrome (SSS) complicated with cardiac dysfunction. Methods Fifty-four patients with SSS were enrolled. Their cardiac function was grade Ⅱ ~ Ⅲ and left ventricular ejection fraction (LVEF) was 35% -50%. According to the longest PR interval of body surface electrocardiogram (ECG), the perceived interventricular septum (SAVD) after implantation of permanent pacemaker was set as 200ms group (A group), 240ms group (13 cases, B group) And 280ms group (15 cases, C group). The average duration of follow-up was (2.2 ± 1.1) years, and concurrent program-controlled pacemaker and echocardiography were performed. Results The ventricular pacing rates in the three groups were (19.3 ± 4.4)%, (18.4 ± 5.2)% and (20.3 ± 4.8)%, respectively (P> 0.05). There were no significant differences in LAD and LVEF between preoperative and postoperative follow-up (P> 0.05). Compared with preoperative and postoperative LVEDD, (P <0.05). The LVEDD in group B and group C were significantly higher than that in group A (P <0.05). Conclusions After implantation of permanent pacemaker in patients with SSS complicated with cardiac insufficiency, SAVD program has the least effect on the cardiac function after 200ms. Excessive prolongation of SAVD can lead to significant increase of LVEDD and impairment of cardiac function.