Victor Frederic, Mabo Philippe, Mansour Hassan, Pavin Dominique, Kabalu Guillaume, de Place Christian, Leclercq Christophe, Daubert J Claude
Department of Cardiology, University Hospital of Rennes, France.
J Cardiovasc Electrophysiol. 2006 Mar;17(3):238-42. doi: 10.1111/j.1540-8167.2006.00358.x.
This study compared chronic right ventricular (RV) pacing at the septum versus apex.
Chronic RV apical pacing may be detrimental to ventricular function. This randomized, pilot study examined whether, compared with apical, permanent septal pacing preserves cardiac function.
Ablation of the atrioventricular junction for permanent AF, followed by implantation of a DDDR pacemaker connected to two ventricular leads was performed in 28 patients. One lead screwed into the septum and another placed at the apex were connected to the atrial and ventricular port, respectively. Septum or apex was paced by programming AAIR or VVIR modes, respectively. Patients were randomly assigned, 4 months later, to pacing at one site for 3 months, and crossed over to the other for 3 months. New York Heart Association class, QRS width and axis, left ventricular ejection fraction (LVEF), exercise duration, and peak oxygen uptake were measured. Results in patients with LVEF > 45% and < or = 45% were compared.
Septal pacing was associated with shorter QRS (145 +/- 4 msec vs 170 +/- 4 msec, P < 0.01) and normal axis (40 degrees +/- 10 degrees vs -71 +/- 4 degrees , P < 0.01). At 3 months, among patients with baseline LVEF < or = 45%, LVEF was 42 +/- 5% after septal pacing versus 37 +/- 4% after apical pacing (P < 0.001).
In contrast to RV apical pacing, chronic RV septal pacing preserved LVEF in patients with baseline LVEF < or = 45%.
本研究比较了右心室（RV）间隔部与心尖部的慢性起搏。
慢性右心室心尖部起搏可能对心室功能有害。这项随机试点研究探讨了与心尖部起搏相比，永久性间隔部起搏是否能保留心脏功能。
对28例永久性房颤患者进行房室结消融，然后植入连接两根心室导线的DDDR起搏器。一根导线拧入间隔部，另一根置于心尖部，分别连接到心房和心室端口。分别通过编程AAIR或VVIR模式进行间隔部或心尖部起搏。4个月后，患者被随机分配在一个部位起搏3个月，然后交叉到另一个部位起搏3个月。测量纽约心脏协会分级、QRS波宽度和电轴、左心室射血分数（LVEF）、运动持续时间和峰值摄氧量。比较LVEF>45%和≤45%患者的结果。
间隔部起搏与较短的QRS波（145±4毫秒对170±4毫秒，P<0.01）和正常电轴（40°±10°对-71±4°，P<0.01）相关。在3个月时，基线LVEF≤45%的患者中，间隔部起搏后LVEF为42±5%，心尖部起搏后为37±4%（P<0.001）。
与右心室心尖部起搏相反，慢性右心室间隔部起搏可保留基线LVEF≤45%患者的LVEF。
