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1、496中国心脏起搏与心电生理杂志2008年第22卷第6期右室心尖部起搏对左室电机械活动的影响1a1b1a1a1a1a1a2任学军张烨韩智红汪烨杜慧峰张金荣陈方郭继鸿[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
2、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(40.1018.50msvs29.9618.87ms,P=0.034);右室起搏后Tei指数明显增加(0.490.23vs0.380.21,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
3、指数;组织多普勒+中图分类号R318.11R540.45文献标识码A文章编号1007-2659(2008)06-0496-031aEffectsofrightventricularpacingonintra-leftventricularmechanicalactivationinpatients.RENXue-jun,1b1a1a1a1a1a2ZHANGYe,HANZh-ihong,WANGYe,DUHu-ifeng,ZHANGJin-rong,CHENFang,GUOJ-ihong.1aDepar-tmento
4、fCardiology,bDepartmentofEchocardiology,AffiliatedBeijingAnzhenHospitalofCapitalUniversityofMedicalSc-ience,BeijingInstituteofHeartLungandBloodVesselDisease,Beijing100029,China;2PeoplesHospitalofBeijingUn-iversity,Beijing100044,China[Abstract]ObjectiveToevaluatewhe
5、therpacingfromtherightventricular(RV)apexaffectsthetissueDopplerpa-rametersofintra-leftventricular(LV)mechanicalmotioncomparedwithspontaneousrhythmvaluesandtoassesswhethertheextentofintra-LVasynchronyduringRVpacingcanbepredictedbyclinica,lelectrocardiographicorechocar
6、diographicfindingsobtainedduringspontaneousrhythm.MethodsTwenty-eightpatientswerestudiedwithnarrowQRS(<110ms)andpreservedatrioventricularconductionwhohadreceivedpermanentDDDpacemakersduetosicksinussyndrome.Eachpa-tientunderwentacompletestandardechocardiographicexami
7、nationandtissueDopplerimagine,inspontaneousrhythmandduringVVIpacingfromtheRVapexatarate10beats/minfasterthanthespontaneousrate.ResultsAbnormalintra-LVTs-SDandsignificantincreaseinTs-SDandTeiindexduringRVpacing(40.1018.50msvs29.9618.87msand0.490.23vs0.380.21,allP
8、﹤0.05)werefoundin64.2%patients.Inmultivariatelogisticregressionanalysis,anabnor-malbaselineTs-SDwasanindependentpredictorofa
