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    QRS波振幅和时限对右室间隔部起搏术后心功能的预测价值

    The value of QRS wave amplitude and time limit in the prediction of cardiac function after right ventricular septal pacing

    • 摘要: 目的探讨QRS波振幅和时限对右室间隔部起搏术后心功能的预测价值。方法入选高度或完全性房室传导阻滞且植入永久起搏器的82例患者,随访术后1年的心室起搏比例、心电图及心脏彩超等资料,剔除心室起搏比例低于90%及起搏器工作异常的患者,最终入选62例患者,按X线影像结果及心室电极头端所在位置,将患者分为低位间隔组(22例)与中位间隔组(20例) 及高位间隔组(19例),比较患者胸导联QRS波总振幅(∑QRSAV),胸导联QRS波起始0.04秒振幅和(∑QRSAV0.04),QRS波时限、起搏QRS波除极开始至R波顶峰时限DR及除极顶峰至除极末时限RE和左室射血分数(LVEF)等,通过对指标的对比分析,以探讨影响右室间隔部起搏术后心功能变化的可能因素,寻求右心室间隔部位的最佳起搏位置。结果:1.3组患者术前基线资料如年龄、性别、基础疾病及EF之间差异无统计学意义。2.术后一年中位组与低位组相比,∑QRSAV大,∑QRSAV0.04大,QRS时限短、DR时限短;EF值均小,但无明显统计学差异。中位组与高位组相比,其心室起搏QRS时限短、∑QRSAV大,∑QRSAV0.04大,DR时限短,EF值高。低位组与高位组相比,指标间差异无统计学意义。3组RE时限差异无统计学意义。3.结合3组资料整体来看, QRS波时限和∑QRSAV对术后LVEV有显著影响(P<0.05),且QRS波时限对术后LVEF的影响大于∑QRSAV。DR时限、∑QRSAV0.04与QRS波时限具有显著的相关性(r=0.973, r=-0.709,P<0.05),∑QRSAV0.04、DR时限与∑QRSAV 具有显著的相关性(r=0.828,r=-0.745,P<0.05),RE时限与∑QRSAV 和QRS波时限的相关性较小(r=-0.423, r=0.683,P<0.05);结论右室中位间隔起搏术后较低位、高位心功能好,QRS波时限和∑QRSAV、 DR时限和∑QRSAV0.04可能可以作为指导起搏器右室电极植入的指标及术后心功能的监测。

       

      Abstract: To investigate the value of QRS wave amplitude and duration in the prediction of cardiac function after right ventricular septum pacing. Methods:82 patients with high or complete atrioventricular block and implanted permanent pacemaker were enrolled. The data of ventricular pacing, electrocardiogram and Echocardiography were followed up for 1 year. Excluding ventricular pacing ratio of less than 90% and pacemaker abnormal work, the final selection of 62 patients, in accordance to X-ray and the position of patients’ ventricular electrode tip, the patients are divided into there groups,called low-interventricular septum(22 cases), middle-interventricular septum(21 cases) and high-interventricular septum(19 cases) .The total amplitude of chest lead QRS wave (ΣQRSAV),the total amplitude of chest lead QRS wave starting at 0.04sec amplitude (ΣQRSAV0.04), QRS wave duration, pacing QRS wave depolarization to R wave peak duration(DR)and depolarization peak to depolarization duration (RE)and left ventricular ejection fraction (LVEF)were compared, through the analysis of the indicators to explore the possible factors of cardiac changes after right ventricular septum pacing , to seek the right ventricular ventricular septum position of the best pacing site. Results: There was no significant difference between baseline data such as age, sex, primarydisease and EF. Compared with the low-interventricular group, the middle group is with largerΣQRSAV, largerΣQRSAV0.04, shorter QRS duration, shorter DR time, smaller EF, but there was no statistics meaning in EF. Compared with the high-interventricular group, the middle group is withthe shorter QRS duration, larger ΣQRSAV, larger ΣQRSAV0.04, shorter DR and higher EF . There was no statistically difference between the low and high groups. There was no significant difference in RE time between the three groups. The QRS duration and ΣQRSAV had a significant effect on LVEF (P <0.05), and the effect of QRS duration on LVEF was greater than that of ΣQRSAV. There was a significant correlation between QRS duration and ΣQRSAV (r = -0.742, P <0.05). (R = 0.973, r = -0.709, P <0.05). (P <0.05), and there was a significant correlation between ΣQRSAV0.04 and QRS duration 0.05); ΣQRSAV0.04, DR had a significant correlation withΣQRSAV (r = 0.828, r = -0.745, P <0.05), RE time had a small correlation withΣQRSAV and QRS duration (r = -0.423, r = 0.683,P <0.05); Conclusion:Compared with low and high groups ,right ventricular middle-interventricular septum pacing has better heart function. QRS duration,ΣQRSAV ,ΣQRSAV0.04, DR duration may be used as indicators to guide right ventricular implantation and monitor postoperative heart function.

       

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