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目的:比较右心室间隔部(RVS)起搏和右心室心尖部(RVA)起搏对血流动力学的影响。方法:20 例置入DDD起搏器的患者,随机均分为2组,RVS组行RVS起搏,RVA组行RVA起搏;对比观察术前与术后心电图QRS波宽度和形态;比较2组术前和术后6个月随访的左室射血分数(LVEF)、心脏指数(CI)、每搏量 (SV)、二尖瓣血流E峰和A峰最大充盈速度比值(E／A)差异。结果:RVA组起搏心电图Ⅱ导联QRS时限度显著长于RVS组[(0．19±0．02)s:(0．12±0．02)s,P<0．01];术前2组LVEF、CI、SV和E／A均差异无统计学意义。与术前相比,RVA组6个月随访的LVEF、CI、SV和E／A均显著降低[(60．7±5．9)％:(54．8±6．4)％, (2．78±0．31):(2．49±0．26),(81．5±10．0):(68．6±12．5),(1．70±0．48):(1．20±0．39),均P<0．05], RVS组无明显变化[(62．7±6,4)％:(61．14±5．8)％,(2．74±0．33):(2．76±0．25),(82．2±9．2):(78．7±11． 5),(1．62±0．49):(1．61±0．40),均P>0．05]。6个月随访RVS组LVEF、CISV、SV、E／A均显著高于RVA 组(均P<0．05)。结论:RVA起搏扰乱了双心室电同步,导致血流动力学恶化,RVS起搏则尽可能地保证了双心室正常电激动和机械收缩顺序,对血流动力学无不良影响。
Objective: To compare hemodynamic effects of right ventricular septal (RVS) pacing and right ventricular apical (RVA) pacing. Methods: Twenty patients with DDD pacemaker were randomly divided into 2 groups. RVS group was given RVS pacing in RVS group and RVA group in RVA group. The width and shape of QRS wave in preoperative and postoperative ECG were compared. The left ventricular ejection fraction (LVEF), cardiac index (CI), stroke volume (SV), peak E velocity of mitral flow and peak A filling velocity (E / A) Differences. Results: The limit of QRS of pacemaker ECG Ⅱ lead in RVA group was significantly longer than that in RVS group [(0.19 ± 0.02) s: (0.12 ± 0.02) s, P <0.01] Group LVEF, CI, SV and E / A were no significant difference. The LVEF, CI, SV and E / A at 6 months follow-up in RVA group were significantly lower than those before surgery [(60.7 ± 5.9)% :( 54.8 ± 6.4)%, .78 ± 0.31): (2.49 ± 0.26), (81.5 ± 10.0) :( 68.6 ± 12.5), (1.70 ± 0.48) :( 1 .20 ± 0.39, P <0.05]. There was no significant change in RVS group [(62.7 ± 6,4)% :( 61.14 ± 5.8)%, (2.74 ± 0) .33) :( 2.76 ± 0.25), (82.2 ± 9.2) :( 78.7 ± 11.5), (1.62 ± 0.49) :( 1.61 ± 0 .40), all P> 0.05]. LVEF, CISV, SV and E / A in RVS group were significantly higher than those in RVA group at 6 months follow-up (all P <0.05). Conclusions: RVA pacing disturbs biventricular electrical synchronization, leading to deterioration of hemodynamics. RVS pacing ensures as much as possible normal biventricular electrical and mechanical contractions with no adverse effect on hemodynamics.