实时三维超声心动图评价右心室不同部位起搏对左心房同步性的影响

发布时间：2018-03-23 16:47

本文选题：起搏器　切入点：人工　出处：《中国医学影像技术》2015年09期

【摘要】：目的采用实时三维超声心动图(RT-3DE)评价右心室心尖部(RVA)和间隔部(RVS)起搏对缓慢性心律失常患者左心房同步性的影响。方法将51例高度或Ⅲ度房室传导阻滞患者分为RVA组(n=31)和RVS组(n=20),采用RT-3DE分别测算患者安置埋藏式心脏起搏器术前和术后1、3、6、12个月的左心房主动射血分数(LAAEF)、左心室射血分数(LVEF)及左心房16节段、12节段、6节段QRS波起点到左心房收缩最小收缩容积的时间标准差(Tmsv-16-SD、Tmsv-12-SD、Tmsv-6-SD)及最大时间差(Tmsv-16-Dif、Tmsv-12-Dif、Tmsv-6-Dif)的变化。并对以上参数进行统计学分析。结果两组术后3、6、12个月的Tmsv-16-SD、Tmsv-12-SD及Tmsv-6-SD和两组术后各时间点的Tmsv-16-Dif、Tmsv-12-Dif、Tmsv-6-Dif均分别较各组术前增高(P均0.05),RVS组术后3、6、12个月Tmsv-16-SD、Tmsv-12-SD、Tmsv-6-SD和Tmsv-16-Dif、Tmsv-12-Dif、Tmsv-6-Dif均小于同时点RVA组(P0.05)。RVS组6、12个月的LAAEF、LVEF均大于同时点RVA组(P0.05)。结论采用RT-3DE检测的左心房各节段达最小容积的最大时间差可较时间标准差更敏感地评价右心室不同部位起搏对左心房同步性的影响。持续RVA和RVS起搏均可导致缓慢性心律失常患者左心房收缩运动失同步化,但RVS起搏的不良影响较小。
[Abstract]:Objective to evaluate the effects of RVA (right ventricular apex) and RVS (septal) pacing on synchronism of left atrium in patients with bradyarrhythmia by real-time three-dimensional echocardiography (RT-3DED). Methods 51 patients with high or third degree atrioventricular block were divided into two groups. The left atrial active ejection fraction (LAAEFF, left ventricular ejection fraction (LVEF) and left ventricular ejection fraction (LVEF) were measured by RT-3DE before and after implantation of implantable pacemaker in RVA group and RVS group, respectively. The starting point of QRS wave in 12 segments and 12 segments of left atrium were measured by RT-3DE. The time standard deviation to the minimum systolic volume of left atrium Tmsv-16-SDTmsv-12-SDTmsv-6-SD1) and the maximum time difference (Tmsv-16-DifMr Tmsv-12-DifMr Tmsv-6-Dif) were analyzed statistically. Results the mean scores of Tmsv-16-SDV Tmsv-12-Difv-12-DifTmsv-6-Dif and Tmsv-16-SDV Tmsv-12-DifTmsv-6-Dif were obtained in the two groups after operation. The levels of Tmsv-16-SDV Tmsv-6-SD and Tmsv-16-DifTmsv-6-SD and Tmsv-16-DifTmsv-6-Dif were lower than those of RVA group (P 0.05. RVS) at 12 months. Conclusion the maximum time difference of minimum volume of left atrial segment measured by RT-3DE is higher than that of RVA group at 12 months. The effects of pacing in different parts of right ventricle on left atrial synchrony were evaluated more sensitively than time standard deviations. Continuous RVA and RVS pacing could lead to the loss of synchronization of left atrial contraction in patients with bradyarrhythmia. However, the adverse effects of RVS pacing were small.
【作者单位】：贵州省人民医院心内科;
【基金】：贵州省优秀科技教育人才省长资金(2012-12) 贵州省卫生计生委科学技术基金(GZWKJ2014-1-047)
【分类号】：R540.45

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