Objective： We are aimed to investigate whether right ventricular mid-septal pacing （RVMSP） is superior to conventional right ventricular apical pacing （RVAP） in improving clinical functional capacity and left ven...Objective： We are aimed to investigate whether right ventricular mid-septal pacing （RVMSP） is superior to conventional right ventricular apical pacing （RVAP） in improving clinical functional capacity and left ventricular ejection fraction （LVEF） for patients with high-degree atrio-ventricular block and moderately depressed left ventricle （LV） function. Methods： Ninety-two patients with high-degree atrio-ventricular block and moderately reduced LVEF （ranging from 35% to 50%） were randomly allocated to RVMSP （n=45） and RVAP （n=47）. New York Heart Association （NYHA） functional class, echocardiographic LVEF, and distance during a 6-min walk test （6MWT） were determined at 18 months after pacemaker implantation. Serum levels of N-terminal pro-brain natriuretic peptide （NT-proBNP） were measured using an enzyme-linked immunosorbent assay （ELISA） kit. Results： Compared with baseline, NYHA functional class remained unchanged at 18 months, distance during 6MVVT （485 m vs. 517 m） and LVEF （36.7% vs. 41.8%） were increased, but BNP levels were reduced （2352 pg/ml vs. 710 pg/ml） in the RVMSP group compared with those in the RVAP group, especially in patients with LVEF 35%-40% （for all comparisons, P〈0.05）. However, clinical function capacity and LV function measurements were not significantly changed in patients with RVAP, despite the pacing measurements being similar in both groups, such as R-wave amplitude and capture threshold. Conclusions： RVMSP provides a better clinical utility, compared with RVAP, in patients with high-degree atrioventricular block and moderately depressed LV function whose LVEF levels ranged from 35% to 40%.展开更多
目的评价中位右室间隔起搏(RVSP)方法的可行性和安全性。方法选择101例行RVSP,右室心尖部起搏(RVAP)126例作对照。在X线指导下将室间隔分四区,分别为His束区、右室流出道间隔区、低位前间隔区和右室流入道间隔区,精确定位RVSP的主动导...目的评价中位右室间隔起搏(RVSP)方法的可行性和安全性。方法选择101例行RVSP,右室心尖部起搏(RVAP)126例作对照。在X线指导下将室间隔分四区,分别为His束区、右室流出道间隔区、低位前间隔区和右室流入道间隔区,精确定位RVSP的主动导线在中位间隔位置。记录术中曝光时间、电极导线植入参数、心电图和术后第3,6,12个月随访资料。结果两组手术曝光时间无差异。RVSP组起搏前后的QRS波形态有稳定的特征性变化,可结合X线用于指导导线定位。RVSP组起搏后的QRS波时限明显小于RVAP组(98.19±22.30 msvs 120.80±24.14 ms,P<0.01),术中两组的心室导线的起搏阈值、电流、阻抗均存在明显差异(0.76±0.30 V vs0.39±0.10 V,0.98±0.52 mA vs 0.36±0.19 mA,690.67±141.64Ωvs 867.16±201.23Ω,P<0.01)。在随访中两组心室起搏阈值和阻抗较稳定。结论在X线指导下将室间隔分区,主动导线能精确、快捷地固定于右室中位间隔部。该部位是较理想的起搏部位,安全可行。展开更多
基金Project supported by the National Natural Science Foundation of China(Nos.30900604 and 81270004)the Shanghai Natural Science Foundation(No.11ZR1422800)+1 种基金the Medical Key Project of Shanghai Science and Technology Commission(No.12411952100)the New Outstanding Youth Program of Shanghai Municipal Commission of Health and Family Planning(No.XYQ2013105),China
文摘Objective： We are aimed to investigate whether right ventricular mid-septal pacing （RVMSP） is superior to conventional right ventricular apical pacing （RVAP） in improving clinical functional capacity and left ventricular ejection fraction （LVEF） for patients with high-degree atrio-ventricular block and moderately depressed left ventricle （LV） function. Methods： Ninety-two patients with high-degree atrio-ventricular block and moderately reduced LVEF （ranging from 35% to 50%） were randomly allocated to RVMSP （n=45） and RVAP （n=47）. New York Heart Association （NYHA） functional class, echocardiographic LVEF, and distance during a 6-min walk test （6MWT） were determined at 18 months after pacemaker implantation. Serum levels of N-terminal pro-brain natriuretic peptide （NT-proBNP） were measured using an enzyme-linked immunosorbent assay （ELISA） kit. Results： Compared with baseline, NYHA functional class remained unchanged at 18 months, distance during 6MVVT （485 m vs. 517 m） and LVEF （36.7% vs. 41.8%） were increased, but BNP levels were reduced （2352 pg/ml vs. 710 pg/ml） in the RVMSP group compared with those in the RVAP group, especially in patients with LVEF 35%-40% （for all comparisons, P〈0.05）. However, clinical function capacity and LV function measurements were not significantly changed in patients with RVAP, despite the pacing measurements being similar in both groups, such as R-wave amplitude and capture threshold. Conclusions： RVMSP provides a better clinical utility, compared with RVAP, in patients with high-degree atrioventricular block and moderately depressed LV function whose LVEF levels ranged from 35% to 40%.
文摘目的评价中位右室间隔起搏(RVSP)方法的可行性和安全性。方法选择101例行RVSP,右室心尖部起搏(RVAP)126例作对照。在X线指导下将室间隔分四区,分别为His束区、右室流出道间隔区、低位前间隔区和右室流入道间隔区,精确定位RVSP的主动导线在中位间隔位置。记录术中曝光时间、电极导线植入参数、心电图和术后第3,6,12个月随访资料。结果两组手术曝光时间无差异。RVSP组起搏前后的QRS波形态有稳定的特征性变化,可结合X线用于指导导线定位。RVSP组起搏后的QRS波时限明显小于RVAP组(98.19±22.30 msvs 120.80±24.14 ms,P<0.01),术中两组的心室导线的起搏阈值、电流、阻抗均存在明显差异(0.76±0.30 V vs0.39±0.10 V,0.98±0.52 mA vs 0.36±0.19 mA,690.67±141.64Ωvs 867.16±201.23Ω,P<0.01)。在随访中两组心室起搏阈值和阻抗较稳定。结论在X线指导下将室间隔分区,主动导线能精确、快捷地固定于右室中位间隔部。该部位是较理想的起搏部位,安全可行。
