低位房间隔起搏在病态窦房结综合征患者阻止新发心房颤动的临床应用

发布时间：2019-02-25 16:11

【摘要】：目的：探讨主动固定电极导线植入右心房低位间隔的有效性；对病态窦房结综合征患者低位房间隔与右心耳起搏后分析心房颤动发生率、比较P波离散度及左心房容积指数,评价对阻止新发心房颤动的有效性。方法：选取2013年2月-2014年4月需要植入永久双腔起搏器的病态窦房结综合征(sick sinus syndrome, SSS)患者66例,分为2组,分别为：低位房间隔(Low atrial septum, LAS)组与右心耳(Right atrial appendage, RAA)组,心房电极随机植入RAA(36例)和LAS(30例),比较手术时间和X线曝光时间,术后随访12个月。取常规12导联体表心电图中图形清晰、基线稳定的心电图测量术后起搏心电图P波最大时限和P波最小时限,计算出P波离散度(P wave duration, Pd)并进行组间比较。最先离开基线的点作为P波起点,最后回到基线的点定义为P波终点, 由同一个人测量。术后1、3、6、12月随访。测量RAA起搏和LAS起搏术后的P波离散度与左心房容积指数(atrial volume index, LAVI),并观察心房颤动(atrial fibrillation, Af)发生情况。结果：(1)两组患者术前基线资料对比无统计学意义。(2)LAS组手术时间、X线曝光时间(单位：m i n)明显长于RAA组,差异有统计学意义(50.1±4.8 v s 42.9±5.5,P0.01；8.1±1.7 v s 5.3±1.5,P0.01)。(3)LA S组房颤发生率(3.3%)较RAA(19.4%)组低。(4)术后1、3、6、12月RAA组P波离散度(单位：ms)较LAS 组的大, 差异有统计学意义(40.78±10.72 v s24.10±10.87；42.13±10.97 v s 23.86±10.76；42.53±11.07vs 25.23±10.92；43.91±11.34 vs 25.30±11.41。p0.01)。(5)术后1月RAA组和LAS组的LAVI(单位：ml/m2)差异无统计学意义(23.80±4.98 vs 22.29±4.12,P=0.19),术后3月、6月、12月RAA组较LAS组的LAVI(单位：ml/m2)大,两者差异有统计学意义(24.01±4.88 vs 21.67±4.13；24.07±5.03 v s21.47±4.36 ； 24.90±5.04 vs 21.22±4.37,P值依次为0.04；0.03；0.01)。结论：病态窦房结综合征患者接受起搏器治疗,LAS起搏优于RAA起搏,但其操作稍复杂。相对于RAA组,术后LAS组房颤发生率可能低,P波离散度降低、LAVI减小,LAS组起搏在阻止新发心房颤动方面可能优于RAA组。
[Abstract]:Objective: to investigate the effectiveness of active fixed electrode wire implantation into the right atrium inferior septum (RASS). The incidence of atrial fibrillation was analyzed in patients with sick sinus syndrome after low atrial septum pacing and right atrial pacing. P wave dispersion and left atrial volume index were compared to evaluate the effectiveness of preventing new atrial fibrillation. Methods: from February 2013 to April 2014, 66 patients with sick sinoatrial node syndrome (sick sinus syndrome, SSS) who needed permanent double chamber pacemaker were divided into two groups: low atrial septal (Low atrial septum, LAS) group and right atrial auricular (Right atrial appendage, group. In RAA group, RAA (36 cases) and LAS (30 cases) were implanted at random. The operation time and X-ray exposure time were compared. The follow-up was 12 months after operation. P wave maximum duration and P wave minimum time were measured by routine 12 lead electrocardiogram with clear pattern and stable baseline. P wave dispersion (P wave duration, Pd) was calculated and compared among groups. The first point out of the baseline is the starting point of P-wave, and the last point back to the baseline is defined as the end point of P-wave, which is measured by the same person. All patients were followed up 1, 3, 6, 12 months after operation. P wave dispersion and left atrial volume index (atrial volume index, LAVI),) were measured after RAA pacing and LAS pacing. The occurrence of (atrial fibrillation, Af) in atrial fibrillation was observed. Results: (1) there was no significant difference in baseline data between the two groups before operation. (2) the operation time and X-ray exposure time in LAS group were significantly longer than those in RAA group. The difference was statistically significant (50.1 卤4.8 vs 42.95.5, P 0.01). The incidence of atrial fibrillation in the LAS group (3.3%) was lower than that in the RAA (19.4%) group. (4) the P wave dispersion in the RAA group was higher than that in the LAS group at 1,3,6,12 months after operation (P < 0.01,). (- 3, P < 0.05, P < 0.01, P < 0.01). The difference was statistically significant (40.78 卤10.72 vs 24.10 卤10.87); 42.13 卤10.97 vs 23.86 卤10.76, 42.53 卤11.07vs 25.232.92; 43.91 卤11.34 vs 25.30 卤11.41.p0.01). (5) there was no significant difference in LAVI (unit: ml/m2) between RAA group and LAS group 1 month after operation (23.80 卤4.98 vs 22.29 卤4.12, P = 0.19). 3 months and 6 months after operation, there was no significant difference in LAVI (unit: ml/m2) between RAA group and LAS group. The LAVI (unit: ml/m2) in RAA group was higher than that in LAS group (24.01 卤4.88 vs 21.67 卤4.13) in December, and the difference was statistically significant (24.01 卤4.88 vs, 21.67 卤4.13). 24.07 卤5.03 v s 21.47 卤4.36; 24.90 卤5.04 vs 21.22 卤4.37 (P = 0.04). Conclusion: LAS pacing is superior to RAA pacing in the treatment of sick sinoatrial node syndrome, but its operation is a little complicated. Compared with RAA group, the incidence of atrial fibrillation in LAS group was lower, P wave dispersion decreased and LAVI decreased. Pacing in LAS group was better than that in RAA group in preventing new atrial fibrillation.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.75

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