| Objective Respectively applying the treatment of biventricular pacing and right ventricular septal pacing in atrioventricular block, to compare the heart function influence of two kinds of pacing mode on pacemaker dependent patients, to provide evidence for the physiological pacing mode selection.Methods Enrolled 24 patients from Sep 2012 to Sep 2013 who should be placed in pacemakers, their primary disease is the second degree, high or third degree atrioventricular block, giving them three chamber pacemaker(right atrial + biventricular) each. Randomly divided into right ventricular septum pacing group(n=12) and biventricular pacing group(n=12). 6 months later, each group crossed into the each other group. The biventricular pacing group programmed into the right ventricular septum pacing group, while the right ventricular septum pacing group programmed into the biventricular pacing group, continued following-up for 6 months. After 12 months to obtain all the data to do the statistical analysis, including 6 minutes walk distance(6MWD), Minnesota living with heart failure questionnaire score(MLHFQ), N terminal brain natriuretic peptide(NT-pro BNP), left ventricular ejection fraction(LVEF), left ventricular end-diastolic dimension(LVEDD), left ventricular end-systolic dimension(LVESD), the duration of QRS, twelve left ventricular segment systolic peak time of standard deviation and twelve segments of left ventricular systole peak maximum delay.Results Compared with biventricular pacing and right ventricular septal pacing before and after, there is no significant difference in the 6MWD(340.67 m vs 347.42 m, P=0.33;279.33 m vs 280.67 m, P=0.35) and MLHFQ(41.25 vs 41.42, P=0.85;44.42 vs 43.83, P=0.5). There is no remarkable difference in the change of two kinds of pacing mode on the data of BNP(2025.91pg/ml vs 2844.26pg/ml, P=0.25;2733.92pg/ml vs 2514.33pg/ml, P=0.41) and LVEF(50.50% vs 50.92%, P=0.38;49.50% vs 50.17%, P=0.40). The change of LVEDD(37.33 mm vs 37.75 mm, P=0.39;40.67 mm vs 39.83 mm, P=0.10)and LVESD(50.91 mm vs 51.25 mm, P=0.34; 54.17 mm vs 54.42 mm, P=0.69) in two groups is of no statistical significance. Compared with right ventricular septal pacing, the QRS wave width of biventricular pacing is significantly narrower(116.83 ms vs 133.25 ms, P=0.000;118.58 ms vs 136.25 ms, P=0.000), the figure of twelve left ventricular segmental systolic peak time of standard deviation in biventricular pacing is smaller(27.83 ms vs 37.58 ms, P=0.004;23.42 ms vs 37.83 ms, P=0.002), and the twelve segments of left ventricular systole peak maximum delay in biventricular pacing is shorter(84.00 ms vs 101.42 ms, P=0.001;86.08 ms vs 101.58 ms, P=0.000).Conclusions For patients with pacemaker dependent, there is no significant difference between the biventricular pacing and right ventricular septum pacing on the effect of cardiac function. Compared with the right septal pacing, biventricular pacing is of no significant advantages in the prevention of pacemaker dependent on cardiac function. For those who haven’t reach the indication of cardiac resynchronization therapy but pacemaker dependent, it’s a wise choice to take right ventricular septal pacing, which is more economic and feasible. |
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