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目的 采用二维斑点追踪技术(STE)评价右心室心尖部起搏(RVAP)和右心室流出道起搏(RVOP)对左心室心肌功能及同步性的影响.方法 选择行DDDR模式起搏器植入的高度或Ⅲ度房室传导阻滞(AVB)患者61例,根据右心室电极位置分为右心室心尖起搏(RVAP)组31例及右心室流出道起搏(RVOP)组30例,在术前及术后(21±5)个月采用STE测量左心室同步性指标(TAS-POST),将TAS-POST≥130ms定义为左心室收缩不同步.结果 术后2年,RVAP组有12例(39％)患者发生左心室不同步,RVOP组有6例(19％)患者发生左心室不同步.尽管RVOP组及RVAP组术后前间壁及间壁TRS均较术前缩短,后壁及侧壁较术前延长(P＜0.05),但RVAP组术后较RVOP组更明显,术后左心室射血分数减低(P＜0.05).增加的TAS-POST是LVEF减低的独立预测因素.结论 RVOP组较RVAP组更接近心室正常的激动顺序,获得更好的血流动力学收益.STE可以准确评价心室激动顺序,检测心肌收缩同步性.“,”Objective To evaluate the different effects of right ventricular outflow tract pacing (RVOP) and the right ventricular apex pacing (RVAP) on the left ventricular (LV) systolic synchrony and myocardial function by speckle tracking echocardiography (STE).Methods 61 patients with severe atrioventricular block were performed an implantation of DDDR pacemaker, 30 patients had pacemaker lead implanted in the right ventricular outflow tract (RVOT group) and 31 at the right ventricular apical site (RVAP group).The LV systolic synchrony was evaluated using STE in the baseline and followup, and a time interval≥130 ms for the absolute difference in time to peak radial strain for the anteroseptal wall versus the posterior wall (TAS-POST) was defined as LV dyssynchrony.Results In RVAP group, 39％ (12/31) patients had developed LV systolic dyssynchrony after 2 years, while 19％ (6/30) patients had developed LV systolic dyssynchrony in RVOP group, and TRS in the anteroseptal was decreased and TRS in posterior wall was increased in both groups, however, the RVAP group was severer than RVOP group, and the left ventricular ejection fraction (LVEF) was reduced in RVAP group (P＜0.05).TAS-POSTwas negatively correlated to LVEF.Conclusions Long-term RVOP is better than RVAP, and STE provide a reliable technique for assessment of left ventricular synchrony.