Stojnić B B, Stojanov P L, Angelkov L, Pavlović S U, Radjen G S, Velimirović D B
Department of Cardiology, Military Medical Academy, Belgrade, Yugoslavia.
Pacing Clin Electrophysiol. 1996 Jun;19(6):940-4. doi: 10.1111/j.1540-8159.1996.tb03390.x.
The effect of right ventricular pacing on left ventricular relaxation was studied in 13 patients (age 62 +/- 3 years), with the atrial sensing ventricular pacing mode (VDD). A control group of similar age (64 +/- 4 years) consisted of 11 patients with atrial pacing (AAI). The timing of events was determined in both groups at similar R-R intervals (921 +/- 77 ms vs 967 +/- 37 ms). The loading conditions as estimated by peak systolic wall stress (afterload) and end-diastolic left ventricular dimensions (preload) were approximately the same in both groups. The ratio of late to early filling velocities were similar in both groups. Dominant changes were: increased preejection period (142 +/- 13 ms vs 95 +/- 15 ms); and higher velocities of isovolumic relaxation flow (60 +/- 34 cm/s vs 25 +/- 4 cm/s) in patients with ventricular pacing. The isovolumic relaxation time was longer in patients with VDD pacing (127 +/- 14 ms vs 108 +/- 12 ms). Anterior systolic interventricular septal motion (paradoxal motion) was recorded in nine patients with VDD pacing and in none of the patients with AAI pacing. Isovolumic relaxation flow was detected during atrial pacing in five (45%) patients and in 13 (100%) patients during atrial sensing ventricular pacing, indicating asynchronous left ventricular relaxation. This data shows that VDD pacing compared to atrial pacing resulted in an altered activation pattern of the left ventricle, associated with delayed onset, asynchronous contraction with interventricular septal motion abnormalities and prolonged asynchronous left ventricular relaxation with abnormal motion manifested by the presence of isovolumic relaxation flow.
在13例患者（年龄62±3岁）中采用心房感知心室起搏模式（VDD）研究右心室起搏对左心室舒张的影响。年龄相似的对照组（64±4岁）由11例心房起搏（AAI）患者组成。两组均在相似的R-R间期（921±77毫秒对967±37毫秒）下确定事件发生时间。两组间由收缩期峰值壁应力（后负荷）和舒张末期左心室尺寸（前负荷）估算的负荷条件大致相同。两组的晚期与早期充盈速度比值相似。主要变化为：心室起搏患者的射血前期延长（142±13毫秒对95±15毫秒）；等容舒张期血流速度更高（60±34厘米/秒对25±4厘米/秒）。VDD起搏患者的等容舒张期时间更长（127±14毫秒对108±12毫秒）。在9例VDD起搏患者中记录到收缩期室间隔前向运动（矛盾运动），而AAI起搏患者中无一例出现。在5例（45%）心房起搏患者和13例（100%）心房感知心室起搏患者的心房起搏期间检测到等容舒张期血流，表明左心室舒张不同步。该数据表明，与心房起搏相比，VDD起搏导致左心室激活模式改变，伴有延迟发作、室间隔运动异常的不同步收缩以及等容舒张期血流存在所表现出的异常运动导致的延长的不同步左心室舒张。
