2022 年第 2 期 第 17 卷

右心室不同部位起搏患者起搏诱导心肌病发生情况的比较研究

Comparative study on pacing-induced cardiomyopathy in patients with different pacing parts of right ventricle

作者：朱琳

英文作者：Zhu Lin

单位：河北省邯郸市中心医院心内四科，邯郸056002

英文单位：The 4th Departments of Cardiology Handan Central Hospital Heibei Province Handan 056002 China

关键词：起搏诱导心肌病；起搏部位；右心室心尖部；右心室流出道

英文关键词：Pacing-inducedcardiomyopathy；Pacingsite；Rightventricularapex；Rightventricularoutflowtract

• 摘要：

• 目的  分析右心室心尖部（RVA）及右心室流出道（RVOT）间隔部起搏患者起搏诱导心肌病（PICM）发生情况的差异。方法  选取2015年4月至2018年4月于河北省邯郸市中心医院接受心脏起搏器治疗的351例患者，筛选其中心脏收缩功能正常且高度或Ⅲ度房室传导阻滞的患者154例，按照起搏部位不同分为RVA起搏组81例（RVA组）和RVOT间隔部起搏组73例（RVOT组）。比较2组术前及术后即刻的心电图QRS波群时限和术前及术后1、2、3年左心房内径（LAD）、左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）。比较2组PICM发生率，分析发生PICM的影响因素。结果  术后即刻RVA组QRS波群时限明显长于RVOT组，差异有统计学意义（P＜0.01）。术后1、2、3年，RVA组LAD、LVEDD均高于术前且高于RVOT组，LVEF均低于术前且低于RVOT组，差异均有统计学意义（均P＜0.05）。RVA组术后1、2、3年PICM发生率均高于RVOT组［6.2%(5/81)比0(0/73)、11.1%(9/81)比0(0/73)、17.3%(14/81)比0(0/73)］，差异均有统计学意义(均P＜0.05)。多元Logistic回归分析结果显示，患者术后发生PICM与起搏部位、起搏QRS波群时限及年龄相关（均P＜0.05）。结论  与RVA起搏比较，RVOT间隔部起搏能改善心脏的结构重构，从而降低PICM的发生率。

• Objective To analyze the difference in pacing-induced cardiomyopathy (PICM) between right ventricular apex (RVA) and right ventricular outflow tract (RVOT). Methods From April 2015 to April 2018, 351 patients with cardiac pacemaker treatment in Handan Central Hospital, Hebei Provinece were selected. Among them, 154 patients with normal cardiac systolic function and high or third-degree atrioventricular block were enrolled. They were divided into RVA pacing group (RVA group, 81 cases) and RVOT septal pacing group (RVOT group, 73 cases). The QRS duration before and after operation, left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) before operation and 1, 2 and 3 years after operation were compared between the two groups. The incidence of PICM between the two groups were compared, and the associated factors of PICM were analyzed. Results Immediately after operation,  QRS duration in RVA group was longer than that in RVOT group (P＜0.01). In 1, 2 and 3 years after operation, LAD and LVEDD in RVA group were higher than those before operation and higher than those in RVOT group; LVEF in RVA group was lower than that before operation and lower than that in RVOT group (all P＜0.05). The incidence of PICM in RVA group in 1, 2 and 3 years after operation was higher than that in RVOT group ［6.2%(5/81) vs 0(0/73), 11.1%(9/81) vs 0(0/73), 17.3%(14/81) vs 0(0/73)］(all P＜0.05). Multivariate Logistic regression analysis showed that the occurrence of PICM was related to pacing site, pacing QRS duration and age (all P＜0.05). Conclusion RVOT septal pacing can improve cardiac structural remodeling and reduce the incidence of PICM.