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右心室流出道起搏对心室收缩同步性和心功能的影响 被引量：3

Right ventricular outflow tract pacing protect ventricular contraction synchrony and function
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摘要 目的本文通过组织多普勒技术分别评价右心室流出道(right ventricular outflow tract,RVOT)起搏和右心室心尖部(right ventricular apex,RVA)起搏对心室收缩同步性和心功能的影响。方法将42例无器质性心脏病的心动过缓患者随机分到 RVA 组(n=14)和 RVOT 组(n=28),起搏器植入术后通过三维超声心动图,将 RVOT 组进一步分为右心室流出道间隔部(right ventricular septum,RVS)组(n=17)和右心室流出道游离壁(right ventricular free wall,RVFW)组(n=11)。通过 QRS 时限、肺动脉射血前间期-主动脉射血前间期(PPEI-APEI)及左心室收缩不同步指数(Ts-SD)评价心室的电机械活动同步性;通过射血分数(ejection factor,EF)及 Tei 指数评价心室功能。结果 (1)起搏后各组的 QRS 时限、PPEI-APEI 和 Ts-SD 都显著增加(P<0.01)。(2)RVA 组和 RVOT 组起搏后 QRS 时限分别为(155.1±12.4)ms 和(143.5±6.7)ms,PPEI-APEI 分别为(-34.85±8.03)ms 和(-28.61±7.79)ms,Ts-SD 分别为(48.72±3.83)ms 和(41.91±3.56)ms(P<0.05)。术后6个月,RVOT 组的心功能指标要优于 RVA 组,两组 Tei 指数分别为0.507±0.08和0.418±0.05(P<0.05)。(3)亚组分析显示,RVA 组、RVFW 组和 RVS 组的 QRS 时限分别为(155.1±12.4)ms、(1473.±5.7)ms 和(141.0±6.2)ms(RVA=RVFW>RVS),PPEI～APEI 分别为(-34.85±8.03)ms、(-36.64±3.20)ms 和(-23.41±4.78)ms(RVA=RVFW>RVS),Ts-SD 分别为(48.72±3.83)ms、(44.65±3.23)ms 和(40.13±2.50)ms(RVA>RVFW>RVS)。术后3个月,3组 Tei 指数分别为0.464±0.063、0.449±0.029和0.393±0.047(RVA=RVFW>RVS)。结论 RVS 起搏后心室同步性优于 RVFW 和 RVA,有助于保护心室功能。 Objective This study used tissue Doppler imaging to compare the differences between right ventricular apex（RVA）and right ventricular outflow tract （RVOT）pacing in contraction synchrony and ventricular function. Methods Forty-two patients （mean age 63.5 ± 10. 4 years） without structural heart disease were randomized into RVA group （n = 14） and RVOT group （n =28）. RVOT group was further divided into right ventricular septum（RVS） group （ n = 17 ） and right ventricular free wall （RVFW） group （ n = 11 ） by 3D-echocardiography. Patients were followed up 1,3,6 months after implantation. Ventricular synchrony was evaluated by QRS duration, PPEI - APEI and Ts-SD, and ventricular function was appraised by Tei index. Resuits Compared with intrinsic rhythm, the QRS duration, PPEI - APEI and Ts-SD were significantly changed during ventricular pacing in all groups. The mean QRS duration was （ 155. 1 ± 12. 4） ms for RVA pacing and （143.5 ±6.7）ms for RVOT pacing （P〈0. 001）. The PPEI -APEI was （ -34.85 ±8.03）ms for RVA pacing and （ -28. 61 ±7. 79）ms for RVOT pacing （P =0. 02）. Ts-SD was （48.72 ±3.83）ms for RVA pacing and（41.91 ±3.56）ms for RVOT pacing （P 〈0. 001）. At 6 months after pacing, the Tei index was 0. 507 ± 0. 08 for RVA pacing and 0. 418 ± 0. 05 for RVOT pacing （ P 〈 0. 05 ）. Sub-group analysis showed that the mean QRS duration for RVA, RVFW and RVS pacing was （ 155. 1 ± 12. 4） ms, （ 147.5 ± 5.7） ms, （ 141.0 ± 6. 2） ms （RVA=RVFW 〉RVS）; the PPEI-APEI was （ -34.85 ±8.03）ms, （ -36.64±3.20）ms and （-23.41±4.78）ms （RVA=RVFW 〉RVS）; Ts-SD was （48.72 ±3.83）ms, （44. 65 ±3.23）ms and （40. 13 ± 2. 50） ms （ RVA 〉 RVFW 〉 RVS）. The mean Tei-index was 0. 464 ± 0. 063, 0. 449 ± 0. 029 and 0. 393 ± 0. 047 for RVA, RVFW and RVS group 3 months after implantation （ RVA = RVFW 〉 RVS）. Con- ~lusions RVS pacing has a less adverse effect on contraction synchrony than RVA and RVFW pacing, and could protect ventricular function better.
作者 刘志敏 陈柯萍 陈若菡 孙欣 华伟 王方正 张澍
机构地区 中国医学科学院 心血管病研究所 北京协和医学院 阜外心血管病医院心律失常诊治中心
出处 《中华心律失常学杂志》 2007年第6期465-470,共6页 Chinese Journal of Cardiac Arrhythmias
关键词 右心室流出道 起搏 同步性 TEI指数 Right ventricular outflow tract Pacing Synchrony Tei index
分类号 R541.7 [医药卫生—心血管疾病] R541 [医药卫生—心血管疾病]
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参考文献9

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共引文献52

同被引文献42

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引证文献3

二级引证文献9

中华心律失常学杂志
2007年 第6期

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