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目的:比较右心室心尖(RVA)及流出道间隔部(RVOT-S)起搏对左心室收缩功能的影响,探讨合理的右心室起搏部位。方法:自2007年8月～2009年12月,36例左室收缩功能正常的完全性房室传导阻滞患者,随机纳入RVA和RVOT-S起搏组,起搏器植入12月后分别测定左室射血分数(LVEF),左室收缩末容量(LVESV),主动脉瓣口速度时间积分(VTI),主动脉与肺动脉瓣开放时间差(QAO-QP),房颤负荷(AFb),自动模式转换(AMS),血浆脑钠尿肽原(NT-proBNP)变化,QRS波宽度,比较两组的差别。结果:起搏12月后RVOT-S组LVEF及VTI明显高于RVA组(均P<0.05);LVESV,QAO-QP,NT-BNP,AFb,AMS及QRS波宽度明显低于RVA组(均P<0.05)。结论:与RVOT-S组相比,RVA长期起搏可导致明显左右心室间以及左室内收缩不同步及左室重构,减低左心室收缩功能,对心室依赖起搏患者应首选RVOT-S为心室电极植入部位。
Objective: To compare the effects of right ventricular apex (RVVA) and RVOT-S pacing on left ventricular systolic function (RVP) and to explore a reasonable right ventricular pacing site. Methods: From August 2007 to December 2009, 36 patients with complete atrioventricular block with normal left ventricular systolic function were randomized into RVA and RVOT-S pacing groups. After implantation for 12 months Left ventricular ejection fraction (LVEF), left ventricular end systolic volume (LVESV), aortic valve velocity time integral (VTI), aortic and pulmonary valve open time difference (QAO-QP), atrial fibrillation load (AFb) AMS, NT-proBNP and QRS width were compared between the two groups. Results: The LVEF and VTI in RVOT-S group were significantly higher than those in RVA group after pacing for 12 months (all P <0.05). The widths of LVESV, QAO-QP, NT-BNP, P <0.05). CONCLUSIONS: Long-term pacing of RVA results in significant left and right ventricular and left ventricular systolic asynchrony and left ventricular remodeling and decreases left ventricular systolic function compared with RVOT-S, and RVOT-S should be the first choice for ventricular-dependent pacing Ventricular electrode implantation site.