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目的研究右室流出道(RVOT)间隔部起搏应用的安全性和有效性。方法入选安装心脏永久起搏器患者65例,按起搏部位随机分为右室流出道间隔部起搏组(31例)和右室心尖部(RVA)起搏组(34例),记录并比较二组术中、术后起搏参数,并比较二组间的QRS时限,记录并比较二组术前、术后的左室舒张末内径(LVEDD)、左室射血分数(EF)。结果所有手术顺利完成,无严重并发症。RVOT主动电极置入15min后可以达到理想的起搏参数。RVOT组的电极导线各项起搏参数与RVA组比较,在置入即刻及以后的随访中无显著性差异。RVOT组的QRS时限较RVA组明显变窄,差异有显著性(p<0.05)。RVA组12个月后EF与术前比较明显下降(32.6±3.8):(58.4±4.6),差异有显著性(p<0.05),RVOT组12个月后EF值与术前比较无明显变化(57.4±4.8):(56.6±4.2);但RVOT组12个月后EF值与RVA组12个月后EF值比较,差异有显著性(p<0.05),(57.4±4.8):(32.6±3.8)。结论 RVOT间隔部起搏是安全可行的,与RVA起搏相比,RVOT间隔部起搏不影响心功能。
Objective To study the safety and effectiveness of RVOT spacer pacing. Methods Sixty-five patients with permanent cardiac pacemakers were enrolled and randomly divided into right ventricular outflow tract septum pacing group (31 cases) and right ventricular apical (RVA) pacing group (34 cases) The intraoperative and postoperative pacing parameters were compared between the two groups. The QRS duration was compared between the two groups. The left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (EF) were recorded and compared before and after operation. Results All operations were successfully completed without serious complications. RVOT active electrode after 15min can reach the ideal pacing parameters. There was no significant difference between the pacing parameters of electrode lead in RVOT group and the RVA group immediately and immediately after implantation. QRS duration in RVOT group was significantly narrower than that in RVA group (p <0.05). There was a significant difference (P <0.05) between EF and 12 months postoperatively in RVA group (32.6 ± 3.8) :( 58.4 ± 4.6), and there was no significant difference in EF between 12 months after RVOT and preoperative (57.4 ± 4.8) :( 56.6 ± 4.2). However, there was a significant difference (P <0.05) between the EF values of 12-month RVOT group and those of the RVA group after 12 months (57.4 ± 4.8) :( 32.6 ± 3.8). Conclusion RVOT spacer pacing is safe and feasible, compared with RVA pacing, RVOT spacer pacing does not affect cardiac function.