Centre for Cardiovascular and Lung Biology, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
Europace. 2011 Jun;13(6):853-8. doi: 10.1093/europace/eur028. Epub 2011 Feb 22.
Clinical trial data show that right ventricular pacing worsens cardiovascular outcomes. The underlying pathophysiology of this is undetermined. We studied the effects of right ventricular pacing on cardiac measures of vascular health (endothelial function), ventricular wall stress (B-type natriuretic peptide), and cardiac reserve (cardiac output response to exercise) in subjects with pacemakers.
Twenty-two subjects [mean age 68.4 ± 8.8 (SD) years] with dual-chamber pacemakers implanted for sino-atrial disease were studied in a randomized crossover study comparing minimal right ventricular pacing [RVP-min; pacing with long atrioventricular delay (AVD)] to maximal right ventricular pacing (RVP-max; pacing with short AVD). Endothelial function was measured with reactive hyperaemia peripheral arterial tonometry. Cardiac output at rest and during exercise was determined using an inert gas rebreathing method. Right ventricular pacing was significantly higher in RVP-max when compared with RVP-min (90 ± 16 vs. 15 ± 20%, P < 0.001). Reactive hyperaemia peripheral arterial tonometry index was significantly lower after RVP-max vs. RVP-min (1.73 ± 0.33 vs. 1.96 ± 0.37, P < 0.05). B-type natriuretic peptide was not significantly different between pacing modes (113 ± 80 vs. 104 ± 108 pg/mL, P = NS). Cardiac output at peak exercise was significantly lower during RVP-max (7.65 ± 3.15 vs. 7.05 ± 2.61 L/min, P < 0.05).
Right ventricular pacing is associated with worsened endothelial function and cardiac reserve.
临床试验数据表明，右心室起搏会恶化心血管结局。其潜在的病理生理学机制尚不清楚。我们研究了右心室起搏对起搏器植入患者的血管健康（内皮功能）、心室壁应激（B 型利钠肽）和心脏储备（运动时心输出量反应）的心脏指标的影响。
在一项比较最小右心室起搏（RVP-min；使用长房室延迟（AVD）起搏）和最大右心室起搏（RVP-max；使用短 AVD 起搏）的随机交叉研究中，我们对 22 名（平均年龄 68.4 ± 8.8[SD]岁）因窦性心动过缓疾病植入双腔起搏器的患者进行了研究。与 RVP-min 相比，RVP-max 时右心室起搏明显更高（90 ± 16%对 15 ± 20%，P < 0.001）。使用惰性气体再呼吸法测定静息和运动时的心输出量。与 RVP-min 相比，RVP-max 后反应性充血外周动脉张力计指数明显降低（1.73 ± 0.33 对 1.96 ± 0.37，P < 0.05）。两种起搏模式之间 B 型利钠肽无显著差异（113 ± 80 对 104 ± 108 pg/mL，P = NS）。在 RVP-max 时，峰值运动时的心输出量明显较低（7.65 ± 3.15 对 7.05 ± 2.61 L/min，P < 0.05）。
右心室起搏与内皮功能和心脏储备恶化有关。
