论文部分内容阅读
目的:探讨食管心电图优化左房室间期（LAVI）改善植入双腔起搏器的三度房室传导阻滞患者心功能的效果。方法:采用前瞻性研究的方法，纳入2017年1月至2018年3月在大连医科大学附属大连市中心医院心血管内科行双腔起搏器植入治疗的三度房室阻滞患者40例，于术后3个月同步行食管导联及体表导联心电图检查测定窦性心律或起搏心律时的房间传导时间（IACT）和室间传导时间（IVCT），并以LAVI=100、110、120、130、140和150 ms为参考值调整起搏器的房室延迟（AVD），通过超声心动图逐次评估并确定最佳的起搏器AVD及其对应的LAVI。所有患者分别于起搏器植入术前、术后3个月AVD调整前、术后3个月AVD调整后、术后6个月、术后12个月及术后18个月行超声心动图检测左室射血分数（LVEF）、二尖瓣口舒张早期血流峰值速度（E）、E峰减速时间（EDT）、二尖瓣环舒张早期运动峰值速度（e′）、等容舒张时间（IVRT）、左房容积（LAV），计算左房容积指数和E/e′。结果:40例患者的窦性心律IACT（55.55 ± 10.33）ms，起搏心律IACT（93.95 ± 12.77）ms，平均IACT（63.20 ± 17.84）ms；最佳LAVI 110~150 （132.00 ± 10.43）ms，其中82.5%（33/40）患者的最佳LAVI在120~140 ms。患者术后3个月AVD调整前至随访终点（术后18个月）LVEF、EDT、IVRT、左房容积指数和E/e′均较术前明显改善，差异有统计学意义（n P<0.01）；术后3个月AVD调整后EDT和IVRT较术后3个月AVD调整前明显改善[（142.15 ± 35.58）ms比（125.94 ± 31.13）ms和（119.52 ± 22.15）ms比（133.92 ± 23.87）ms]，差异有统计学意义（n P<0.05）；术后18个月IVRT和左房容积指数较术后3个月AVD调整前明显改善[（122.07 ± 16.99）ms比（133.92 ± 23.87）和32.94 ± 3.22比35.43 ± 5.76]，差异有统计学意义（n P<0.05）。n 结论:通过食管心电图可以测量LAVI并优化起搏器AVD，能够最大程度实现房室同步，改善因三度房室阻滞植入双腔起搏器患者的心功能。“,”Objective:To study the effect of left atrioventricular interphase (LAVI) via esophageal electrocardiogram on cardiac function after dual-chamber pacemaker implantation in patients with high-degree atrioventricular block.Methods:Using a prospective approach, 40 patients with high-degree atrioventricular block who would undergo dual-chamber pacemaker implantation from January 2017 to March 2018 in Department of Cardiovascular Medicine, Dalian Municipal Central Hospital Affiliated of Dalian Medical University were enrolled. All patients accepted esophageal electrocardiogram tests at 3 months after the implantation, to exam the interatrial conduction time (IACT) of sinus rhythm and pacing rhythm, and interventricular conduction time (IVCT). Then based on the outcome of the echocardiography test, the optimal atrioventricular delay (AVD) of the pacemaker of each patient was determined while the LAVI differed from 100 ms to 150 ms. The left ventricular ejection fraction (LVEF), peak speed of blood flow velocity in early mitral orifice diastole (E), E peak deceleration time (EDT), peak speed of early mitral annular diastolic movement (e′), isovolumic relaxation time (IVRT) and left atrial volume (LAV) were tested by echocardiogram before implantation, before AVD adjustment at 3 months after implantation, after AVD adjustment at 3 months after implantation, and 6, 12, and 18 months after implantation. Then, the left atrial volume index (LAV/body surface area) and E/e′ were calculated.Results:Among the 40 patients, the IACT of sinus rhythm was (55.55 ± 10.33) ms, the IACT of pacing rhythm was (93.95 ± 12.77) ms, and the mean IVCT was (63.20 ± 17.84) ms; the optimal LAVI was 110 to 150 (132.00 ± 10.43) ms, and notably, the optimal LAVI between 120 and 140 ms was 82.5% (33/40). The LVEF, EDT, IVRT, left atrial volume index and E/e′ from before AVD adjustment of 3 months after implantation to follow-up endpoint (18 months after implantation) were significantly improved compared with those before implantation, and there were statistical differences (n P<0.01); the EDT and IVRT after AVD adjustment at 3 months after implantation were significantly improved than those before AVD adjustment at 3 months after implantation: (142.15 ± 35.58) ms vs. (125.94 ± 31.13) ms and (119.52 ± 22.15) ms vs. (133.92 ± 23.87) ms, and there were statistical differences (n P<0.05); the IVRT and left atrial volume index 18 months after implantation were significantly improved compared with those before AVD adjustment at 3 months after implantation: (122.07 ± 16.99) ms vs. (133.92 ± 23.87) and 32.94 ± 3.22 vs. 35.43 ± 5.76, and there were statistical differences (n P<0.05).n Conclusions:Optimizing the LAVI after dual-chamber pacemaker implantation via esophageal electrocardiogram can improve the long-term prognosis of patients with high-degree atrioventricular block.