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目的:评价右室心尖部起搏对老年患者心脏功能的影响。方法:入选因缓慢性心律失常安装心脏永久起搏器的老年患者(年龄≥60岁)115例。所有患者均为心房电极位于右心耳,心室电极置于右室心尖部;VVI型起搏器60例,DDD型起搏器55例。按最终心室累积起搏百分比(Cum%VP)分为3组:A组Cum%VP<50%(34例),B组Cum%VP≥50%~<100%(38例),C组为完全心室起搏,即Cum%VP=100%(43例)。通过询问患者自觉症状,行运动耐量、左室射血分数(LVEF)及脑利钠肽(BNP)水平的检查,了解各组及不同起搏模式患者术前、后心功能的变化。结果:①术后18个月,与术前比较,3组均有心功能恶化趋势,即LVEF、BNP均有降低、升高的改变,但A组的改变幅度最小,C组的改变幅度最大,B组介于两者之间;②VVI与DDD起搏相比,对心功能的影响无差异,VVI起搏患者心房颤动和脑栓塞发生率略高。结论:①老年患者在右室心尖部起搏情况下,随着Cum%VP的增加,心功能恶化程度增大;②VVI或DDD起搏模式不是影响老年患者心功能的决定因素。
Objective: To evaluate the effect of right ventricular apical pacing on cardiac function in elderly patients. Methods: A total of 115 elderly patients (≥60 years old) with a permanent cardiac pacemaker were recruited due to bradyarrhythmia. All patients were atrial electrode located in the right atrial appendage, ventricular electrode placed in the apex of right ventricle; VVI pacemaker in 60 cases, 55 DDD-type pacemaker. According to the percentage of final ventricular cumulative pacing (Cum% VP), Cum% VP was less than 50% (34 cases) in group A, and Cum% VP was more than 50% ~ <100% Complete ventricular pacing, ie Cum% VP = 100% (43 cases). The patients’ symptoms, exercise tolerance, left ventricular ejection fraction (LVEF) and brain natriuretic peptide (BNP) levels were examined to find out the changes of cardiac function before and after the operation in each group and different pacing modes. Results: ① At 18 months after operation, the cardiac function was worsened in all three groups compared with that before operation, that is, LVEF and BNP both decreased and increased. However, the changes in group A were the smallest and those in group C were the largest. B group was in between the two; VVI compared with DDD pacing, no difference in the impact on cardiac function, VVI pacing in patients with atrial fibrillation and cerebral embolism slightly higher incidence. Conclusions: (1) With the increase of Cum% VP in elderly patients with right ventricular apical pacing, the worsening of cardiac function is increased. (2) VVI or DDD pacing mode is not the determinant of cardiac function in elderly patients.