右室心尖部起搏对左室电机械活动的影响任学军1a�张烨1b�韩智红1a�汪烨1a�杜慧峰1a�张金荣1a�陈方1a�郭继鸿2[摘要]�目的�运用超声心动图和组织多普勒检查,分析右室心尖部起搏对左室电机械活动的影响;探讨能够预测右室心尖部起搏后左室内机械活动不同步性的因素。方法�选取因病窦综合征置入双腔永久起搏器的患者28例,术后7天分别测量患者在自身心律、VVI起搏两种状态下的超声心动图和组织多普勒心功能指数(Tei指数)、左室内不同步指数(Ts-SD)等参数并分析左室内机械活动不同步的影响因素。结果�64.2%的患者在右室起搏期间,表现为左室机械活动的不同步;Ts-SD显著增加(40.10�18.50msvs29.96�18.87ms,P=0.034);右室起搏后Tei指数明显增加(0.49�0.23vs0.38�0.21,P﹤0.01);自身心律状态下的Ts-SD指数是右室起搏时出现左室收缩不同步现象的独立预测因素(OR=1.079,P=0.029)。结论�右室心尖部起搏导致左右心室之间及左室内收缩不同步,对患者心脏整体功能带来不利的影响。[关键词]�心血管病学;右室心尖部起搏;左室内不同步指数;组织多普勒中图分类号�R318.11�R540.4+5��文献标识码�A��文章编号�1007-2659(2008)06-0496-03Effectsofrightventricularpacingonintra-leftventricularmechanicalactivationinpatients.RENXue-jun1a,ZHANGYe1b,HANZh-ihong1a,WANGYe1a,DUHu-ifeng1a,ZHANGJin-rong1a,CHENFang1a,GUOJ-ihong2.1aDepar-tmentofCardiology,bDepartmentofEchocardiology,AffiliatedBeijingAnzhenHospitalofCapitalUniversityofMedicalSc-ience,BeijingInstituteofHeartLungandBloodVesselDisease,Beijing100029,China;2People�sHospitalofBeijingUn-iversity,Beijing100044,China[Abstract]�Objective�Toevaluatewhetherpacingfromtherightventricular(RV)apexaffectsthetissueDopplerpa-rametersofintra-leftventricular(LV)mechanicalmotioncomparedwithspontaneousrhythmvaluesandtoassesswhethertheextentofintra-LVasynchronyduringRVpacingcanbepredictedbyclinica,lelectrocardiographicorechocardiographicfindingsobtainedduringspontaneousrhythm.�Methods�Twenty-eightpatientswerestudiedwithnarrowQRS(<110ms)andpreservedatrioventricularconductionwhohadreceivedpermanentDDDpacemakersduetosicksinussyndrome.Eachpa-tientunderwentacompletestandardechocardiographicexaminationandtissueDopplerimagine,inspontaneousrhythmandduringVVIpacingfromtheRVapexatarate10beats/minfasterthanthespontaneousrate.�Results�Abnormalintra-LVTs-SDandsignificantincreaseinTs-SDandTeiindexduringRVpacing(40.10�18.50msvs29.96�18.87msand0.49�0.23vs0.38�0.21,allP﹤0.05)werefoundin64.2%patients.Inmultivariatelogisticregressionanalysis,anabnor-malbaselineTs-SDwasanindependentpredictorofasynchronyofleftventricularcontractionduringRVpacing.�Conclu-sion�PacingfromtheapexofRVinducesasynchronyofleftventricularcontractionsinasubstantialpercentageofpatientsbutnotinal.lThepresenceofpreimplantedLVasynchronypredictsforaworseningofthisdetrimentaleffect.[ChineseJournalofCardiacPacingandElectrophysiology,2008,22(6):496-498][Keywords]�Cardiology;Rightventricularapexpacing;intra-leftventricularasynchronousindex;tissueDopplerimagine作者单位:1�首都医科大学附属北京安贞医院a心内科;b超声心动图室(北京100029)2�北京大学人民医院作者简介:任学军(1966-),女(汉族),北京人,主任医师,副教授,医学博士,研究方向为心脏起搏与电生理。��近年来,大规模随机临床试验均表明双腔房室顺序起搏(DDD)优势有限。与单腔心室起搏(VVI)相比,DDD起搏的死亡率和卒中发生率无差别。当DDD伴有高比例的右室心尖部起搏(RVA)时,心室不同步抵消了房室同步起搏的益处,导致心房颤动和心力衰竭(简称心衰)住院率增加。评价左室收缩同步性的方法很多,而应用超声心动图评价左室运动的同步性是近些年来研究的热点。包括M超...
