Alboni P, Scarfò S, Fucà G, Mele D, Dinelli M, Paparella N
Divisione di Cardiologia, Ospedale Civile, Cento, FE.
G Ital Cardiol. 1998 Mar;28(3):237-41.
Recently, short-term hemodynamic benefits of right ventricular outflow tract (RVOT) or proximal septum (His bundle area) pacing have been reported in comparison with traditional apical stimulation in preliminary investigations. The purpose of the present study was to compare the hemodynamics obtained during DDD pacing from ventricular apex, RVOT and proximal septum in patients with normal left ventricular function. A simultaneous hemodynamic and Doppler-echocardiographic study was performed in 21 patients (age 67 +/- 7 years) with sick-sinus syndrome (8 pts) or 2nd-3rd degree atrioventricular (AV) block (13 pts). The three stimulation sites were randomized and pacing was applied at an identical rate (84 +/- 5 beats/min) and at a constant AV delay (150 ms). Electrocardiographic, hemodynamic and Doppler-echocardiographic investigations were performed during stimulation from each site. The QRS duration did not show significant differences during DDD pacing from ventricular apex, RVOT and proximal septum. The hemodynamic measurements (systemic pressures, mean pulmonary wedge pressure, pulmonary pressures, right ventricular end-diastolic pressure, mean right atrial pressure, cardiac index, systemic vascular resistance and arteriovenous O2 difference) did not show significant differences during pacing from the three sites. Moreover, no significant differences were observed for the Doppler-echocardiographic measurements of systolic function (aortic stroke distance, left ventricular ejection fraction) and diastolic function (isovolumetric relaxion time, mitral E/A ratio, deceleration rate of the E wave). The results suggest that in patients with normal left ventricular function DDD pacing from RVOT or proximal septum does not improve cardiac function with regard to apical pacing.
最近，在初步研究中，与传统的心尖刺激相比，右心室流出道（RVOT）或近端间隔（希氏束区域）起搏的短期血流动力学益处已有报道。本研究的目的是比较左心室功能正常的患者在心室心尖、RVOT和近端间隔进行DDD起搏时的血流动力学情况。对21例患有病态窦房结综合征（8例）或二度至三度房室传导阻滞（13例）的患者（年龄67±7岁）进行了同步血流动力学和多普勒超声心动图研究。三个刺激部位随机选取，以相同的频率（84±5次/分钟）和恒定的房室延迟（150毫秒）进行起搏。在每个部位刺激期间进行心电图、血流动力学和多普勒超声心动图检查。在心室心尖、RVOT和近端间隔进行DDD起搏时，QRS波时限未显示出显著差异。血流动力学测量值（体循环压力、平均肺楔压、肺压力、右心室舒张末期压力、平均右心房压力、心脏指数、体循环血管阻力和动静脉氧分压差）在三个部位起搏时未显示出显著差异。此外，对于收缩功能（主动脉搏出距离、左心室射血分数）和舒张功能（等容舒张时间、二尖瓣E/A比值、E波减速速率）的多普勒超声心动图测量，也未观察到显著差异。结果表明，对于左心室功能正常的患者，从RVOT或近端间隔进行DDD起搏在心脏功能方面并不优于心尖起搏。
