QRS波时限和起搏部位对右心室起搏期间急性血流动力学变化的影响。

The effects of QRS duration and pacing sites on the acute hemodynamic changes during right ventricular pacing.

作者信息

Hong Young Joon, Yang Bo Ra, Sim Doo Seon, Lim Sang Yup, Lee Sang Hyun, Lim Ji Hyun, Kim Han Gyun, Park Ok Young, Kim Ju Han, Kim Weon, Kim Nam Ho, Ahn Young Keun, Jeong Myung Ho, Cho Jeong Gwan, Park Jong Chun, Kang Jung Chaee

机构信息

The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangiu, Korea.

出版信息

Korean J Intern Med. 2005 Mar;20(1):15-20. doi: 10.3904/kjim.2005.20.1.15.

DOI:10.3904/kjim.2005.20.1.15

PMID:15906948

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3891407/

Abstract

BACKGROUND

Has been reported that patients exhibiting prolonged paced QRS duration tend to have more serious heart disease, and the paced QRS duration can be an effective indicator of impaired left ventricular function. However, the acute and chronic hemodynamic effects of paced QRS duration and pacing sites during right ventricular (RV) pacing remain unknown.

METHODS

A total of 14 patients who underwent electrophysiologic study for paroxysmal supraventricular tachycardia were examined. RV pacing was performed at 10 different sites with cycle lengths of 600 ms and 500 ms utilizing a 6-7F deflectable quadripolar electrode catheter. Systolic, diastolic, and mean blood pressures during pacing were measured once the blood pressure was stabilized.

RESULTS

During RV pacing, blood pressures (systolic/diastolic/mean) decreased. The change of post-pacing QRS duration and pre-pacing the systolic blood pressure (SBP) were greater in the group with paced QRS duration. The differences overall were greater than 140 ms. The SBP decrease during pacing was larger in the group exhibiting paced QRS duration of greater than 140 ms. The SBP decrease during pacing showed relation to QRS duration during pacing (r = 0.500, p = 0.001), the change of QRS duration post-pacing (r = 0.426, p = 0.001), and SBP during sinus rhythm (r = 0.342, p = 0.001) on linear correlation analysis. The pacing site, on the other hand, did not affect acute hemodynamic changes during pacing.

CONCLUSION

Ventricular pacing of less than 40 ms at the area of paced QRS duration is recommended.

摘要

背景

据报道，起搏QRS时限延长的患者往往患有更严重的心脏病，起搏QRS时限可作为左心室功能受损的有效指标。然而，右心室（RV）起搏期间起搏QRS时限和起搏部位的急性和慢性血流动力学效应仍不清楚。

方法

对14例因阵发性室上性心动过速接受电生理检查的患者进行了研究。使用6-7F可弯曲四极电极导管在10个不同部位进行RV起搏，起搏周期长度分别为600 ms和500 ms。血压稳定后测量起搏期间的收缩压、舒张压和平均血压。

结果

在RV起搏期间，血压（收缩压/舒张压/平均压）下降。起搏QRS时限组起搏后QRS时限和起搏前收缩压（SBP）的变化更大。总体差异大于140 ms。起搏QRS时限大于140 ms的组起搏期间SBP下降幅度更大。线性相关分析显示，起搏期间SBP下降与起搏期间QRS时限（r = 0.500，p = 0.001）、起搏后QRS时限变化（r = 0.426，p = 0.001）以及窦性心律时的SBP（r = 0.342，p = 0.001）有关。另一方面，起搏部位不影响起搏期间的急性血流动力学变化。