右室高位间隔部与心尖部VVI起搏对左心功能及三尖瓣返流影响的比较

张 博; 江 珊; 刘华子; 朱 进

右室高位间隔部与心尖部VVI起搏对左心功能及三尖瓣返流影响的比较

Effect of lead at high right interventricular septum and ventricular apex on cardiac functions and tricuspid regurgitation in patients implanted with VVI permanent pacemakers

摘要

摘要: 目的:探讨右室高位间隔部起搏（HRVS）与右室心尖部起搏(RVA)对左心功能及右心三尖瓣返流的影响。方法： 52例接受心室按需型起搏器（VVI）起搏并愿意接受随访的患者，其中接受HRVS起搏27例，接受RVA起搏25例，分别于术前、术后、术后1周、术后12个月、术后24个月在同一起搏频率（65次/min）用超声心动图测量左室射血分数（LVEF），左室短轴缩短率（LVFS），三尖瓣返流(TR)和监测血浆脑钠尿肽（BNP）水平。结果： HRVS起搏患者LVEF、LVFS、TR及BNP水平无明显改变，RVA起搏患者LVEF、LVFS降低，TR轻微返流增加，BNP水平升高。结论： HRVS起搏优于RVA起搏，表明右室生理性起搏的重要性。

Abstract: AIM:To determine the effect of lead at high right interventricular septum (HRVS) and right ventricular apex (RVA) on cardiac functions and tricuspid regurgitation (TR). METHODS: A 2year followup was conducted in 52 cases implanted with VVI permanent pacemakers, including 27 cases of lead at HRVS and 25 cases of lead at RVA. Cardiac function and tricuspid regurgitation were measured with the same pacing frequency (65 1/min) at 1 week, 6 months, 1 year and 2 years postimplantation. Left ventricular ejection fraction (LVEF), fractional shortening (LVFS) and tricuspid regurgitation (TR) were measured with echocardiogram and brain natriuretic peptide (BNP) was monitored. RESULTS: Lead at HRVS did not significantly affect LVEF, BNP and tricuspid regurgitation. Lead at RVA deteriorated cardiac functions and increased tricuspid regurgitation. CONCLUSION: Pacing at HRVS is superior to pacing at RVA, indicating the importance of physiological pacing of high right interventricular septum.

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