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目的应用组织多普勒方法随机对照研究右室流出道间隔部(RVOT)与右室心尖部(RVA)起搏对心室同步性的影响。方法缓慢心律失常病例128例,所有患者起搏器植入术后1、3和6个月定期随访,观察起搏参数、累积心室起搏百分比,组织多普勒评价心室同步性。结果RVOT组和RVA组QRS时限有差异(P<0.01)。随访6个月心室累计起搏数、起搏阈值及起搏感知差异无显著性(P>0.05)。术后随访第1、3和6个月,RVOT起搏组的同步指标明显优于RVA起搏组(P均<0.01);左室射血分数在RVA组有所降低,第6个月RVOT组的射血分数优于RVA组(P<0.05)。结论右室心尖部起搏导致心脏收缩不同步,损害左室功能。流出道间隔部起搏保持良好心脏收缩同步性,是较好的右室起搏部位。
Objective To evaluate the effects of right ventricular outflow tract (RVOT) and right ventricular apical (RVA) pacing on ventricular synchrony using tissue Doppler method. Methods A total of 128 cases of bradyarrhythmia cases were included in this study. All patients were followed up at 1, 3 and 6 months after implantation of pacemaker. Pacing parameters, percentage of ventricular pacing and tissue Doppler were used to evaluate ventricular synchrony. Results There were significant differences in QRS duration between RVOT group and RVA group (P <0.01). There was no significant difference in pacing threshold and pacing sense between 6 months follow-up ventricular cumulative pacing (P> 0.05). The RVOT pacing group was significantly better than the RVA pacing group on the 1st, 3rd, and 6th month after surgery (all P <0.01). The left ventricular ejection fraction decreased in the RVA group and the RVOT Group ejection fraction better than the RVA group (P <0.05). Conclusion Right atrial apical pacing leads to unsynchronized cardiac contractility and impairs left ventricular function. Outflow tract septal pacing to maintain good systolic synchrony, is a good right ventricular pacing site.