右室中位间隔起搏治疗缓慢型心律失常的临床效果观察【摘要】目的：评价应用主动固定电极行右室中位间隔起搏治疗缓慢型心律失常的可行性、有效性与安全性。方法：选择2014年9月-2015年9月在本院心血管内科行永久性起搏器植入术的缓慢型心律失常患者40例，随机分成两组，每组各20例，分别行右室中位间隔起搏（RVSP组）和右室心尖部起搏组（RVAP组）。并对比两组心室电极植入时间、术中透视吋间，心室起搏心电图QRS波群宽度，术毕与术后3个月电极阈值、感知、阻抗，术前与术后3个月左室射血分数（LVEF）、室间隔与左室后壁运动延迟吋间（SPWMD）等指标，并记录术中、术后相关不良反应。结果:与RVAP组相比，RVSP组电极植入时间与透视时间比较差异无统计学意义（P>0.05）o两组术毕及术后3个月阈值、感知、阻抗，以及术前与术后3个月LVEF比较差异均无统计学意义（P>0.05）o与RVAP组相比,RVSP组心室起搏心电图QRS波形较窄，SPWMD更少，两组比较差异均有统计学意义（P〈0.01）。本试验中未发现围术期相关的不良反应。结论：主动固定电极右室中位间隔起搏安全有效，适宜县区级医院临床推广应用。【关键词】右室中位间隔；主动固定电极；缓慢型心律失常；起搏器【Abstract】Objective:Toevaluatethefeasibility,availability,andsafetyofrightventricularmid-septalpacing(RVSP)techniquebyusingactivefixationleadinpatientswithbradyarrhythmia.Method:Fortypatientsdiagnosedwithbradyarrhythmiawereselectedinourhospital,fromSeptember2014toSeptember2015.PatientswererandomlyassignedtoRVSPgroupandRVAPgroup,20casesineachgroup・Theventricularelectrodeimplantationtime,intra-operativeradiationtime,andthewidthofQRSwaveofventricularpacingECGoftwogroupswererecorded.Immediatelyand3monthesafterthesurgery,thethreshold,perceptionandimpedanceofventricularelectrodeoftwogroupswerecompared；beforeand3monthesafterthesurgery,leftventricularejectionfraction(LVEF)andseptal-to-posteriorwallmotiondelay(SPWMD)oftwogroupswerecompared.Besides,theperi-operativeadverseeventsoftwogroupswereobserved.Result：Therewasnosignifiedntdiffereneeinthetimeofventricularelectrodeimplantationandintra-operativeradiation(P>0.05).Comparedthethreshold,perception,andimpedanceofventricularelectrodeoftwogroupsinimmediatelyand3monthesafterthesurgery,aswellastheLVEFbeforeand3monthesafterthesurgery,thedifferenceswerenostatisticallysignificant(P>0.05)•MorenarrowofthewidthQRSwaveofventricularpacingECGandlessSPWMDinRVSPgroupthanRVAPgroup,thedifferencewerestatisticallysignificant(P<0.05)•Therewerenoadverseeventsintwogroupsduringperi~operation.Conclusion：RVSPbyusingactivefixationleadisthesafeandeffectivetechniqueinpatientswithbradyarrhythmia・【Keywords］Rightventricularmid-septalpacing；Activefixationlead；Bradyarrhythmia；PacemakerFirst-author'saddress：XinhuiHospitalAffiliatedtoSouthernMedicalUniversily,.Jiangmen529100,Chinadoi：10.3969/j.issn.1674-4985.2016.19.007起搏器是治疗缓慢型心律失常的有效手段，本院己独立开展起搏器植入术逾20年。但传统术式中的右室心尖部起搏（RVAP）改变了心脏正常的电激动顺序，己被证实为非理想的永久起搏位点［1］。右室中位间隔起搏（RVSP）起搏位点更接近正常的心脏传导系统希氏束（Ilisbundle）,符合生理激动顺序，且电极植入相对简单便捷。鉴于县区级医院开展生理性起搏治疗的经验有限，故本研究拟探索RVSP治疗缓慢型心律失常的可行性与安全性，为RVSP术式在基层医院的推广，改善起搏器患者预后和生活质量提供临床依据。1资料与方法1.1一般资料本研究经南方医科大学附属新会医院伦理审查委员会审批，患者知情同意并签署同意书。选择2014年9月-2015年9月在本院心血管内科行永久性起搏器植入的缓慢型心律失常患者40例，所有患者均符合2008年ACC/AHA/HRS发布的《2008...