论文部分内容阅读
目的:经胸CT确定心室电极位置,分析右室间隔起搏与心尖起搏对左心功能及心室同步性的影响。方法:82例需安装永久起搏器并需心室起搏依赖的患者随机分为右室间隔起搏组(RVS组,40例)和右室心尖起搏组(RVA组,42例)。RVS组术后行胸CT检查并分析测量电极顶端的垂直距离和水平距离。两组均于术后1个月和9个月时行心脏超声检查,测量左室舒张末期内径(LVEDD)、左室射血分数(LVEF)及主动脉流速积分(AVTI),测量并计算室间机械延迟(IVMD)及左室各节段的达峰时间标准差(Ts-SD)。结果:经胸CT确定在后前位下,电极的理想位置为横向上三分之一和纵向三区之间的区域;术后1个月及9个月随访时,两组LVEDD、LVEF和AVTI相比无统计学差异,术后9个月两组IVMD及Ts-SD均差异有统计学意义(均P<0.05);QRS波时限与达峰时间差及Ts-SD呈正相关。结论:对心功能正常的起搏依赖患者,右室间隔起搏与心尖起搏短中期时左室功能未见明显不同,但右室间隔起搏有益于维持室间及室内收缩同步性。
OBJECTIVE: To determine the location of ventricular electrodes by CT and analyze the influence of right ventricular septal pacing and apex pacing on left ventricular function and ventricular synchrony. Methods: Eighty-two patients with permanent pacemaker who needed ventricular pacing-dependent pacing were randomly divided into right ventricular pacing group (RVS group, 40 cases) and right ventricular apical pacing group (RVA group, 42 cases). RVS group underwent chest CT examination and analysis of vertical and horizontal electrode electrode distance measurement. Cardiac echocardiography was performed at 1 month and 9 months after operation in both groups, LVEDD, LVEF and AVTI were measured. Mechanical delay (IVMD) and standard deviation of peak time (Ts-SD) of each segment of the left ventricle. Results: Computed tomography (CT) showed that in the posterior position, the ideal position of the electrode was the region between one third of the transverse direction and the longitudinal three regions. At 1 month and 9 months after the operation, the LVEDD, LVEF and There was no significant difference between AVTI and AVTI. There was significant difference of IVMD and Ts-SD between the two groups after 9 months (all P <0.05). The QRS wave duration was positively correlated with peak time difference and Ts-SD. CONCLUSIONS: There is no significant difference in left ventricular function between right ventricular septal pacing and apical pacing short to mid-term for pacing-dependent patients with normal cardiac function, but right ventricular septal pacing is beneficial in maintaining the synchrony of both ventricular and ventricular contractions.