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目的观察心脏不同部位起搏时体表心电图评价心室肌复极指标的变化,了解不同部位起搏对心室肌整体复极离散的影响。方法 10只健康猪,分别在右心房(RA)、右心室心尖部心内膜(RVEndo)及左心室心外膜(LVEpi)起搏,记录并测量体表心电图12个导联的T波峰-末间期(Tpe)和QT间期,计算Tpe平均值(Tpe-AVE)、Tpe最大值(Tpe-MAX)以及QT间期离散度(QTd),比较不同部位起搏时上述各参数的差异,进一步评价不同起部位对心室整体复极离散的影响。结果 LVEpi、RA、RVEndo起搏时的QT间期分别为(328±24)ms、(295±13)ms、(304±17)ms,LVEpi起搏时的QT间期明显长于RA及RVEndo起搏时的QT间期(P<0.05),RA与RVEndo起搏时QT间期没有明显差别。LVEpi、RA、RVEndo起搏的QT离散度(QTd)分别为(33±6)ms、(17±3)ms、(18±3)ms,LVEpi起搏时的QTd明显大于RA及RVEndo起搏时的QTd(P>0.05),RA与RVEndo起搏时QTd没有明显差别(P>0.05)。RA起搏时Tpe-AVE及Tpe-MAX分别为49±6ms及58±8 ms,与RVEndo起搏相近(49±8)ms及(60±8)ms,P>0.05);LVEpi起搏时Tpe-AVE及Tpe-MAX明显增大(63±7)ms及(71±8)ms,与RA、RVEndo起搏时比较两者(P<0.05)。结论与RA及RVEndo起搏时比较,LVEpi起搏时的QT间期、QTd、Tpe-AVE及Tpe-MAX均明显增大,LVEpi起搏可能会增加心室整体复极离散。
Objective To observe the change of ventricular repolarization index by surface electrocardiogram during pacing in different parts of heart, and to understand the effect of pacing in different parts on ventricular total repolarization. Methods Twenty healthy pigs were implanted in right atrium (RA), right ventricular endocardium (RVEndo) and left ventricular epicardium (LVEpi) respectively. T wave peak - (Tpe-AVE), Tpe-MAX and QTd interval (QTd) were calculated for Tpe and QT interval. The differences between the above parameters during pacing were compared , To further evaluate the impact of different parts of the ventricular complex repolarization. Results The QT interval of LVEpi, RA, and RVEndo was (328 ± 24) ms, (295 ± 13) ms and (304 ± 17) ms respectively. The QT interval of LVEpi pacing was significantly longer than that of RA and RVEndo QT interval (P <0.05), there was no significant difference between QT interval of RA and RVEndo pacing. The QTd of LVEpi, RA and RVEndo pacing were (33 ± 6) ms, (17 ± 3) ms and (18 ± 3) ms respectively. QTd in LVEpi pacing was significantly higher than that in RA and RVEndo pacing (P> 0.05). There was no significant difference in QTd between RA and RVEndo pacing (P> 0.05). Tpe-AVE and Tpe-MAX were 49 ± 6 ms and 58 ± 8 ms, respectively, which were similar to those of RVEndo pacing (49 ± 8 ms and (60 ± 8) ms, P> 0.05) Tpe-AVE and Tpe-MAX increased significantly (63 ± 7) ms and (71 ± 8) ms, respectively, compared with those in RA and RVEndo pacing (P <0.05). Conclusion Compared with RA and RVEndo pacing, the QT interval, QTd, Tpe-AVE and Tpe-MAX of LVEpi pacing are significantly increased. LVEpi pacing may increase the overall ventricular repolarization dispersion.