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目的观察植入双腔起搏器的病窦综合征(均无房室传导阻滞)患者行右心耳起搏时对左室舒张功能的影响。方法入选36例植入双腔起搏器的病窦综合征患者,分别在窦性心律和右心耳起搏情况下用彩色超声多普勒测定二尖瓣口快速充盈期峰值血流速度(Ep)、二尖瓣口左房收缩期峰值血流速度(Ap)、二尖瓣环后壁处收缩期峰值血流速度平均值(Vs)、二尖瓣环后壁处舒张早期峰值血流速度平均值(Ve)、二尖瓣环后壁处舒张晚期峰值血流速度平均值(Va)、等容舒张时间(IVRT)、左室射血分数(LVEF)、左室短轴缩短率(LVFS)各参数,通过Ep/Ap、Ve/Va、IVRT评价左室舒张功能,Vs、LVEF、LVFS评价左室收缩功能。结果在心房激动完全经房室结下传激动心室的情况下,两组间Ep/Ap、Ve/Va、IVRT均有显著差异[1.35±0.65vs 0.96±0.53;1.06±0.45vs 0.88±0.53;(0.55±0.05)ms vs(0.56±0.05)ms;P均<0.01],Vs、LVEF、LVFS差异无显著性。结论右心耳起搏可导致左室舒张功能下降,短期内对收缩功能无明显影响。
Objective To observe the effect of right atrial appendage pacing on left ventricular diastolic function in patients with sick sinus syndrome (without atrioventricular block) implanted with dual chamber pacemaker. Methods 36 cases of sick sinus syndrome patients with double-chamber pacemaker were enrolled in this study. Peak flow velocities of mitral valve during rapid filling were measured by color Doppler sonography in sinus rhythm and right atrial appendage (Ep ), Peak systolic velocity (Ap), mean systolic peak velocity (Vs) at the posterior wall of the mitral annulus, early diastolic peak velocity at the posterior wall of mitral annulus (Ve), mean peak diastolic velocity (Va), IVRT, LVEF, LVFS (LVFS) in the posterior wall of the mitral annulus, ) Parameters of left ventricular diastolic function were evaluated by the parameters of Ep / Ap, Ve / Va, IVRT, left ventricular diastolic function, Vs, LVEF and LVFS. Results In the case of atrial activation, the ventricular activation was completely transmited by atrioventricular node, there were significant differences in Ep / Ap, Ve / Va and IVRT between the two groups [1.35 ± 0.65 vs 0.96 ± 0.53; 1.06 ± 0.45 vs 0.88 ± 0.53; (0.55 ± 0.05) ms vs (0.56 ± 0.05) ms, P <0.01, respectively. There was no significant difference between Vs, LVEF and LVFS. Conclusions Right atrial appendage pacing leads to decreased left ventricular diastolic function and no significant effect on systolic function in short term.