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目的评价右室流出道(RVOT)和右室心尖部(RVA)起搏对心脏收缩同步性、收缩功能和左室重构的影响。方法82例高度或III度房室传导阻滞患者随机分为RVOT起搏组(A组,n=43)和RVA起搏组(B组,n=39),以术前左室12节段达峰时间标准差(Ts-SD)是否>32.6ms对两组患者进行亚组分组,Ts-SD>32.6ms者为A1亚组与B1亚组,Ts-SD≤32.6ms为A2亚组与B2亚组。于术前及术后6个月分别进行超声心动图检查,测量舒张末左室容积(LVEDV)、收缩末左室容积(LVESV)、左室射血分数(LVEF),并采集组织多普勒图像(TDI)进行脱机分析,测量主动脉瓣射血前时间(APET)、肺动脉瓣射血前时间(PPET)、左室12节段收缩达峰时间(Ts),计算室间电机械延迟(IVMD)和Ts-SD。结果术后6个月,两组的IVMD均较术前增加;两组Ts-SD与术前比无差异。亚组分析表明术前同步性好的A2、B2亚组术后Ts-SD升高;术前同步性差的A1亚组术后Ts-SD降低。术后6个月两组LVEDV、LVESV及LVEF与术前比较均无差异,组间比较亦无差异。结论RVOT和RVA起搏短期内对左室收缩功能及左室重构均无影响,术前收缩不同步者可从RVOT起搏中获益。
Objective To evaluate the effects of right ventricular outflow tract (RVOT) and right ventricular apical (RVA) pacing on systolic synchrony, systolic function and left ventricular remodeling. Methods Eighty-two patients with height or III degree atrioventricular block were randomly divided into RVOT pacing group (group A, n = 43) and RVA pacing group (group B, n = 39) Ts-SD> 32.6ms, subgroups were divided into two groups, Ts-SD> 32.6ms were A1 subgroup and B1 subgroup, Ts-SD≤32.6ms subgroup A2 and B2 subgroup group. Echocardiography was performed preoperatively and 6 months after surgery to measure left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF), and tissue Doppler (TDI) were measured offline to measure aortic valve ejection time (APET), pulmonary valve ejection time (PPET), left ventricular systolic peak time (Ts) (IVMD) and Ts-SD. Results At 6 months after operation, the IVMD in both groups increased compared with that before operation; there was no difference between the two groups in pre-operation and before operation. Subgroup analysis showed that Ts-SD of A2 and B2 subgroups with good preoperative synchronization were higher than those of A1 subgroups with poor preoperative synchronization. There was no difference in LVEDV, LVESV and LVEF between the two groups at 6 months after operation and there was no difference between the two groups. Conclusions RVOT and RVA pacing have no effect on left ventricular systolic function and left ventricular remodeling in a short period of time. RVOT pacing can benefit from non-synchronized preoperative contractions.