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目的:通过右心室流出道间隔部(RVOTS)起搏与右心室心尖部(RVA)起搏的比较,评价RVOTS起搏的临床可行性与安全性。方法:选择慢性心房颤动(房颤)伴长R-R间歇或缓慢心室率需植入永久起搏器患者68例,随机分配到RVOTS组(n=34)和RVA组(n=34),RVOTS组将螺旋电极导线主动固定于RVOTS,RVA组将传统的翼状电极被动固定于右心室心尖部。分别记录每例患者术中X线曝光时间;术中及术后15 min、1、6、12个月时电极导线测试参数以及是否有并发症发生;测量自身及术后起搏心电图的QRS时限。结果:RVOTS组术中X线曝光时间(12.8±5.4)min较RVA组(9.5±2.1)min长(P<0.01),但随着手术熟练程度的增加,RVOTS组X线曝光时间逐渐缩短并接近RVA组;RVOTS组电极导线植入即刻起搏阈值与RVA组无统计学差异,导线植入15 min后及术后1、6、12个月时两组间起搏阈值无统计学差异;两组间R波振幅及阻抗在术中及术后各时期均无统计学差异;RVOTS组起搏心电图的QRS时限较RVA组显著缩短[(146±16)msvs.(155±13)ms,P<0.05];术中及随访期内无电极脱位、阈值增高、心肌穿孔及心包压塞等并发症。结论:使用主动固定电极导线进行RVOTS起搏安全可行,且心室激动的电同步性优于RVA组。
OBJECTIVE: To evaluate the clinical feasibility and safety of RVOTS pacing by comparing right ventricular outflow tract septum (RVOTS) pacemaker with right ventricular apex (RVA) pacing. Methods: Sixty-eight patients with permanent atrial pacemaker (RR) who had permanent RR or intermittent ventricular rate were randomly assigned to RVOTS group (n = 34) and RVA group (n = 34) Actively fix the spiral electrode lead to RVOTS. The RVA group passively fixes the traditional wing electrode to the apex of the right ventricle. The X-ray exposure time of each patient was recorded separately. The parameters of electrode leads and the complications were recorded at 15 min, 1, 6, 12 months after operation and after operation. The QRS time limit of self and postoperative pacemaker electrocardiogram . Results: The X-ray exposure time of RVOTS group was longer (12.8 ± 5.4) min than that of RVA group (9.5 ± 2.1) min (P <0.01), but with the increase of operative proficiency, the X-ray exposure time of RVOTS group was shortened Close to the RVA group. There was no significant difference between the RVOTS group and the RVA group in terms of immediate pacing threshold. There was no significant difference in pacing threshold between the two groups after 15 min of wire implantation and at 1, 6, There were no significant differences in R wave amplitude and impedance between the two groups during the operation and postoperative periods. The QRS duration of pacing ECG in RVOTS group was significantly shorter than that in RVA group [(146 ± 16) ms vs (155 ± 13) ms, P <0.05]; no intraoperative and follow-up of electrode dislocation, increased threshold, myocardial perforation and tamponade and other complications. CONCLUSIONS: The use of active fixed electrode leads for RVOTS pacing is safe and feasible, and electrical synchronization of ventricular activation is superior to RVA.