Rimbas Roxana Cristina, Margulescu Andrei Dumitru, Siliste Calin, Vinereanu Dragos
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania ; Emergency University Hospital, Bucharest, Romania ; "Victor Babes" National Institute, Bucharest, Romania.
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Maedica (Bucur). 2014 Sep;9(3):232-41.
Left ventricular function and synchrony may be altered by right ventricular (RV) apical pacing. Septal pacing might be a better alternative. We compared effects on cardiac synchrony and function, between the 2 pacing sites, in chronically implanted patients.
40 pacing-dependent patients (74±9 years, 21 men), 20 paced at the apex, were studied 11±4 months after implantation (baseline); 32 of them were re-examined after 1 year. Systolic function was assessed from ejection fraction (EF), cardiac index (CI), mean longitudinal systolic strain (MLSS), and strain rate (MLSR); diastolic function from E/A, E/E', and E/Vp ratios. Intraventricular dyssynchrony from standard deviation (SSD) and maximal difference (MAXS) of the 12 LV myocardial systolic timings, and sum of all times from the aortic valve closure to peak strain (SUMTAVC) for those segments with post-systolic shortening; interventricular synchrony from the aorto-pulmonary delay (APD).
Four patients died, all of them from the apical group. NYHA functional class was not different. Cardiac synchrony was not significantly different between the two pacing sites at baseline, and after 1 year follow-up. Although at baseline there was a greater dyssynchrony for the septal site, this did not progress at follow-up, whereas this increased for the apical site. Meanwhile, there was a higher LV filling pressure (E/E' ratio) for the apical site at 1 year (13±6 vs.18±6; p=0.04).
Both septal and apical pacing sites affect negatively LV mechanical activation timings and synchrony. Apical, but not septal site, affects LV synchrony at 1 year, associated with increased filling pressure.
右心室心尖部起搏可能会改变左心室功能和同步性。间隔起搏可能是更好的选择。我们比较了在长期植入患者中，这两种起搏部位对心脏同步性和功能的影响。
40例起搏依赖患者（年龄74±9岁，男性21例），其中20例在心尖部起搏，于植入后11±4个月（基线）进行研究；其中32例在1年后再次接受检查。通过射血分数（EF）、心脏指数（CI）、平均纵向收缩应变（MLSS）和应变率（MLSR）评估收缩功能；通过E/A、E/E'和E/Vp比值评估舒张功能。通过12个左心室心肌收缩时间的标准差（SSD）和最大差值（MAXS）以及收缩后缩短节段从主动脉瓣关闭到应变峰值的所有时间总和（SUMTAVC）评估心室内不同步性；通过主肺动脉延迟（APD）评估心室间同步性。
4例患者死亡，均来自心尖部起搏组。纽约心脏协会（NYHA）功能分级无差异。在基线时和1年随访后，两个起搏部位之间的心脏同步性无显著差异。虽然在基线时间隔部位的不同步性更大，但在随访中并未进展，而心尖部部位的不同步性增加。同时，心尖部部位在1年时左心室充盈压（E/E'比值）更高（13±6对18±6；p = 0.04）。
间隔和心尖部起搏部位均对左心室机械激活时间和同步性产生负面影响。心尖部起搏部位（而非间隔部位）在1年时影响左心室同步性，并伴有充盈压升高。
