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目的评价右室中位间隔、右室心尖部起搏及其他部位起搏对植入起搏器患者长期预后的影响。方法据X线、心脏彩超及心电图标准,准确的将入选患者分为右室中位间隔起搏组(RVMSP组)、右室心尖部起搏组(RVAP组)及其他部位三组,回顾性分析长期随访后全因死亡、新发心力衰竭(简称心衰)及心房颤动(简称房颤)、心源性再入院的发生率。结果 364例患者(RVMSP=147例,RVAP=105例,其他部位=112例)经(57.2±10.1)个月随访,三组间新发心衰发生率RVMSP组及其他部位组发生率明显低于RVAP组(17.8%vs 17.0%vs 29.5%,P<0.05),三组之间死亡率无统计学差异(P=0.420),但较RVAP组,RVMSP组死亡率较低(4.8%vs 8.6%)。三组间新发房颤(P=0.973)及心源性再入院率(P=0.286)无差别。术后QRS波时限和心尖部起搏是新发心衰的预测因素。结论 RVMSP及其它间隔起搏较传统右室心尖部起搏,能减少新发心衰的发生率。
Objective To evaluate the long-term prognosis of patients undergoing pacemaker implantation with right ventricular median septum, right atrial apical pacing and other parts of pacing. Methods According to the standard of X-ray, echocardiography and electrocardiogram, the patients were divided into three groups randomly: the right ventricular septal pacing group (RVMSP group), the right ventricular apical pacing group (RVAP group) and other sites, retrospectively Analysis of long-term follow-up all-cause death, new heart failure (referred to as heart failure) and atrial fibrillation (atrial fibrillation), cardiac re-admission incidence. Results A total of 364 patients (RVMSP = 147, RVAP = 105 and other sites = 112) were followed up for (57.2 ± 10.1) months. The incidence of new-onset HF was significantly lower in the RVMSP and other groups There were no significant differences among the three groups (P = 0.420) in the RVAP group (17.8% vs 17.0% vs 29.5%, P <0.05), but the mortality was lower in the RVMSP group than in the RVAP group (4.8% vs 8.6 %). There were no differences in new-onset atrial fibrillation (P = 0.973) and cardiac rehospitalization (P = 0.286) among the three groups. Postoperative QRS wave duration and apical pacing were predictors of new-onset heart failure. Conclusion RVMSP and other interval pacing more than conventional right ventricular apical pacing can reduce the incidence of new heart failure.