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1、雙腔起搏器最小化心室起搏策略對(duì)心衰患者心功能的影響摘要目的:比較自動(dòng)房室搜索(SearchAV)和心室起搏管理(managedventricularpacing,MVP)模式下,雙腔起搏器植入的心衰患者其心功能變化情況。方法:選取58例因病態(tài)竇房結(jié)綜合征植入雙腔起搏器的患者,采用右心室流出道起搏方式,隨機(jī)分為SearchAV組和MVP組,植入起搏器后分別啟用SearchAV模式和MVP模式,隨訪12個(gè)月,比較兩組心室起搏比例差異以及術(shù)前及術(shù)后12個(gè)月心功能指標(biāo)和血漿NT-ProBNP水平差異。結(jié)果:M
2、VP組心室起搏比例較SearchAV組心室起搏比例明顯減少(0.5%vs4.2%,P<0.01);SearchAV組左室射血分?jǐn)?shù)術(shù)后下降、E/A比值下降,而MVP組射血分?jǐn)?shù)及E/A比值的變化沒有統(tǒng)計(jì)學(xué)意義。兩組患者術(shù)后12個(gè)月NT-ProBNP較術(shù)前均有所增加,SearchAV組較MVP組增加更為明顯(456pg/mlvs258pg/ml,P<0.05)。結(jié)論:對(duì)于病態(tài)竇房結(jié)綜合征植入雙腔起搏器的心衰患者,右心室流出道起搏狀態(tài)下,MVP模式較SearchAV模式對(duì)患者長期的心臟收縮和舒張功能影響較小。
3、關(guān)鍵詞心室起搏管理自動(dòng)房室搜索心力衰竭心臟功能ImpactsofdifferentstrategiestominimizingventricularpacingonpatientswithheartfailureAbstractObjective:Toevaluatecardiacfunctionchangesinpatientsofheartfailure,whoreceiveddualchamberpacemakerimplantationbetweentwoalgorithms:managedv
4、entricularpacing(MVP)andsearchatriaventricle(SearchAV)becauseofsicksinussyndrome.Methods:Atotalof58patientsreceivedpermanentdualchamberpacemakerforsicksinussyndromeweredividedintoMVPgroupandSearchAVgrouprandomly.Managedventricularpacingorsearchatriavent
5、riclealgorithmswereusedaccordinglyafterthepacemakerwereimplanted.Thepercentagesofventricularpacing,indexofechocardiographyandplasmaNT-ProBNPwererecordedbeforetheoperationsandafter12monthsfollow-up.Results:ThepercentagesofventricularpacingwaslowerinMVPgr
6、oupthaninSearchAVgroup(0.5%vs4.2%,P<0.01).TheLVEFfalledandtheE/AratiodecreasedintheSearchAVgroupafter12monthsfollow-up,yettheMVPgrouphadnostatisticallysignificantchanges.TheplasmaNT-ProBNPincreasedinbothgroupsandtheSearchAVgroupincreasedmore(456pg/mlvs2
7、58pg/ml,P<0.05).Conclusion:MVPalgorithmhaslessinfluencethanSearchAValgorithmonthepatients’heartsystolicanddiastolicfunctions,whohadheartfailureandreceiveddualchamberpacemakerimplantationbecauseofsicksinussyndrome.Keywords:managedventricularpacing;Search
8、AV;heartfailure;heartfunction雙腔起搏器是目前國內(nèi)植入率最高的起搏器,如何優(yōu)化其起搏部位,改變起搏方式,最小化心室起搏成為當(dāng)前研究熱點(diǎn)。在如何盡量減少右室起搏從而降低由右室起搏所帶來的不利的血流動(dòng)力學(xué)效應(yīng)方面,心室起搏管理(managedventricularpacingMVP)和自動(dòng)房室搜索(SearchAV)是目前最有代表性的兩種最小化心室起搏的策略,兩種策略孰優(yōu)孰劣目前還有爭議[1-2]。本研究選取在我院行右心室流出道起