右室间隔主动电极起搏治疗缓慢性室性心律失常的安全性及有效性
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摘要
目的:评价右室间隔主动电极起搏治疗缓慢性室性心律失常的安全性及有效性。方法:选择因缓慢性室性心律失常需植入永久性起搏器患者共56例(其中植入DDD起搏器患者42例),术后第1、3、6、12个月随访,12个月后每年随访1次,特殊情况即时就诊。术后第6个月时评估患者临床症状、生活质量、6min步行距离、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)指标及起搏参数,对比术前、术后6个月上述各指标的变化。结果:起搏器植入术后6个月,患者生活质量、6min步行距离、血清B型脑钠肽(brain natriuretic peptide,BNP)测定值较术前明显改善,差异有统计学意义(P<0.05);LVEF、LVEDD差异无统计学意义;在部分轻度心功能不全患者中,LVEF及大小变化差异有统计学意义(P<0.05)。结论:右室间隔起搏安全可行,能增加左心室射血分数且不影响双心室同步性,可替代右心室心尖部起搏。
Objective:To evaluate the safety and efficacy of right ventricular active electrode on cardiac function in patients with bradycardiac arrhythmia.Methods:A total of 56 patients with bradycardiac arrhythmia who needed permanent pacemaker implantation were enrolled(42 patients were implanted with DDD pacemaker).Follow-up was carried out at the 1 st,3 rd,6 th,and 12 th months after operation,and once a year after 12 months.The patients' clinical symptoms,quality of life,6-min walk test(6 MWT),serum level of brain natriuretic(BNP),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),and pacing parameters were evaluated at the 6 th month after surgery.The changes of the above indexes before and 6 months after surgery were compared.Results:Six months after pacemaker implantation,the quality of life,6 MWT and BNP measurements of patients were significantly improved compared with those before surgery,the difference was statistically significant(P<0.05).But there was no statistical difference between LVEF and LVEDD.In some patients with mild cardiac insufficiency,the LVEF difference was statistically significant(P<0.05).Conclusions:Right ventricular septal pacing is safe and feasible.It can increase left ventricular ejection fraction without affecting biventricular synchrony and can replace right ventricular apex pacing.
Objective:To evaluate the safety and efficacy of right ventricular active electrode on cardiac function in patients with bradycardiac arrhythmia.Methods:A total of 56 patients with bradycardiac arrhythmia who needed permanent pacemaker implantation were enrolled(42 patients were implanted with DDD pacemaker).Follow-up was carried out at the 1 st,3 rd,6 th,and 12 th months after operation,and once a year after 12 months.The patients' clinical symptoms,quality of life,6-min walk test(6 MWT),serum level of brain natriuretic(BNP),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),and pacing parameters were evaluated at the 6 th month after surgery.The changes of the above indexes before and 6 months after surgery were compared.Results:Six months after pacemaker implantation,the quality of life,6 MWT and BNP measurements of patients were significantly improved compared with those before surgery,the difference was statistically significant(P<0.05).But there was no statistical difference between LVEF and LVEDD.In some patients with mild cardiac insufficiency,the LVEF difference was statistically significant(P<0.05).Conclusions:Right ventricular septal pacing is safe and feasible.It can increase left ventricular ejection fraction without affecting biventricular synchrony and can replace right ventricular apex pacing.
引文
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[11]王娜,梁延春,于海波,等.希氏束起搏在需要高比例心室起搏的窄QRS波群患者中应用探讨[J].中国心脏起搏与心电生理杂志,2017,31(5):401-407.
[12]MOLINA L,SUTTON R,GANDOY W,et al.Mediumterm effects of septal and apical pacing in pacemakerdependent patients:a double-blind prospective randomized study[J].Pacing Clin Electrophysiol,2014,37(2):207-214.
[13]YUSU S,MERA H,HOSHIDA K,et al.Selective site pacing from the right ventricular mid-septum.Follow-up of lead performance and procedure technique[J].Int Heart J,2012,53(2):113-116.
[14]CHEN K,MAO Y,LIU S H,et al.Is right ventricular midseptal pacing superior to apical pacing in patients with high degree atrio-ventricular block and moderately depressed left ventricular function?[J].J Zhejiang Univ Sci B,2014,15(6):507-514.
[15]PONIKOWSKI P,VOORS A A,ANKER S D,et al.2016ESC guidelines for the diagnosis and treatment of acute and chronic heart failure:the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology(ESC)developed with the special contribution of the Heart Failure Association(HFA)of the ESC[J].Eur Heart J,2016,37(27):2129-2200.
[2]孙玉杰,张海澄.2013EHRA/ESC心脏起搏器和心脏再同步治疗指南解读[J].中国医学前沿杂志(电子版),2013,5(11):65-69.
[3]AUGER D,HOKE U,MARSAN N A,et al.Effect of induced LV dyssynchrony by right ventricular apical pacing on all-cause mortality and heart failure hospitalization rates at long-term follow-up[J].J Cardiovasc Electrophysiol,2014,25(6):631-637.
[4]白明,李强,张钲,等.右室中位间隔起搏的可行性与安全性[J].中国心脏起搏与心电生理杂志,2011,25(6):499-502.
[5]候勃,蔡尚郎,孙品,等.右室心尖部起搏与右室流出道起搏对Ⅲ度房室传导阻滞患者疗效的对比研究[J].临床心血管病杂志,2010,26(3):184-186.
[6]章少波,蔡建生,彭志坚.永久性人工起搏器植入术后心功能变化的研究[J].吉林医学,2011,32(18):3626-3627.
[7]WANG F,SHI H,SUN Y,et al.Right ventricular outflow pacing induces less regional wall motion abnormalities in the left ventricle compared with apical pacing[J].Europace,2012,14(3):351-357.
[8]KIKUCHI M,TANO K,MIYOSHI F,et al.Long-term effectiveness of right septal pacing vs right apical pacing in patients with atrioventricular block[J].J Arrhythm,2012,28(4):214-218.
[9]LORGUESCU C,RADU D A,CONSTANTINESCU D,et al.Right ventricular septal pacing-clinica and electrical predictors for LV contraction asynchrony[J].J Med Life,2014,7(Spec Iss 4):83-89.
[10]VIJAVARAMAN P,DANDAMUDI G,ZANON F,et al.Permanent his bundle pacing:recommendations from a multicenter his bundle pacing collaborative working group for standardization of definitions,implant measurements,and follow-up[J].Heart Rhythm,2018,15(3):460-468.
[11]王娜,梁延春,于海波,等.希氏束起搏在需要高比例心室起搏的窄QRS波群患者中应用探讨[J].中国心脏起搏与心电生理杂志,2017,31(5):401-407.
[12]MOLINA L,SUTTON R,GANDOY W,et al.Mediumterm effects of septal and apical pacing in pacemakerdependent patients:a double-blind prospective randomized study[J].Pacing Clin Electrophysiol,2014,37(2):207-214.
[13]YUSU S,MERA H,HOSHIDA K,et al.Selective site pacing from the right ventricular mid-septum.Follow-up of lead performance and procedure technique[J].Int Heart J,2012,53(2):113-116.
[14]CHEN K,MAO Y,LIU S H,et al.Is right ventricular midseptal pacing superior to apical pacing in patients with high degree atrio-ventricular block and moderately depressed left ventricular function?[J].J Zhejiang Univ Sci B,2014,15(6):507-514.
[15]PONIKOWSKI P,VOORS A A,ANKER S D,et al.2016ESC guidelines for the diagnosis and treatment of acute and chronic heart failure:the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology(ESC)developed with the special contribution of the Heart Failure Association(HFA)of the ESC[J].Eur Heart J,2016,37(27):2129-2200.