Bai Ming, Li Qiang, Jiang Gaxue, Zhang Lu, Wang Tao, Zhang Zheng
Department of Cardiology, First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China.
Eur Heart J Suppl. 2016 May;18(Suppl F):F12-F18. doi: 10.1093/eurheartj/suw031. Epub 2016 May 24.
The aim of the present study was to compare conventional right ventricular apical pacing (RVAP) with right ventricular mid-septal pacing (RVMSP) in terms of echocardiographic and clinical/biologic features. Ninety-six patients with high-degree atrioventricular block were randomly allocated to RVMSP ( = 50) and RVAP ( = 46). Threshold and impedance, echocardiographic left ventricular ejection fraction, ventricular dyssynchrony features, and distance during a 6-min walk test and Minnesota Living with Heart Failure Questionnaire were determined at 6 and 12 months after pacemaker implantation. Serum levels of N-terminal pro-brain natriuretic peptide were measured. At 6 months of follow-up, echocardiographic and clinical/biologic features showed no significant differences between two groups. The RVAP group had more intraventricular dyssynchrony and a trend towards a worse left ventricular ejection fraction compared with the RVMSP at 12 months of follow-up. However, no overt clinical benefits from RVMSP were found. Right ventricular mid-septal pacing was associated with decreased dyssynchrony and better left ventricular ejection fraction compared with the RVAP. Right ventricular mid-septal pacing could represent an alternative pacing site in selected patients to reduce the harmful effects of traditional RVAP.
本研究的目的是在超声心动图及临床/生物学特征方面，比较传统右心室心尖部起搏（RVAP）与右心室中隔部起搏（RVMSP）。96例高度房室传导阻滞患者被随机分为RVMSP组（n = 50）和RVAP组（n = 46）。在起搏器植入后6个月和12个月时，测定起搏阈值和阻抗、超声心动图左心室射血分数、心室不同步特征、6分钟步行试验中的距离以及明尼苏达心力衰竭生活问卷。检测血清N末端脑钠肽前体水平。随访6个月时，两组的超声心动图及临床/生物学特征无显著差异。随访12个月时，与RVMSP组相比，RVAP组存在更多的室内不同步，左心室射血分数有变差的趋势。然而，未发现RVMSP有明显的临床益处。与RVAP相比，右心室中隔部起搏与不同步减少及更好的左心室射血分数相关。对于特定患者，右心室中隔部起搏可能是一个替代起搏部位，以减少传统RVAP的有害影响。
