| Objective: To investigate the effect of pacing at different cardiac sites on plasma NT-pro BNP levels in elderly patients during perioperative period,and to further reflect its effect on cardiac function.Based on the above effects,it can provide a more physiological pacing mode for patients who meet the pacemaker implantation indications.Methods: In this study,all cases were collected from cardiovascular medicine department of Linyi People’s Hospital.The duration of admission was from January 1,2018 to December 31,2018.Moreover,the total sample size was 75 elderly patients.In terms of sample conditions,all patients met the 2010 consensus of Chinese pacemaker implantation experts for category II A and above indications.For patients with type II or above atrioventricular block implanted with dual-chamber pacemaker,seventy-five patients were divided into three groups according to the patient’s hospitalization order.Specific grouping criteria are as follows: right ventricular apex pacing group,non-selective His bundle pacing group and left bundle branch pacing group.And excluded:1.Except for serious liver,renal insufficiency,acute infection,metabolic disorders,tumors and other diseases;2.Slow and fast syndrome implantation of single chamberpacemaker;3.Hypertrophic cardiomyopathy implantation of pacemaker;4.Patients with cardiac ultrasound suggesting a left ventricular ejection fraction ≤ 40% or a left ventricular end diastolic diameter≥60 mm.Two ml of venous blood was collected before and 7 days after operation.The plasma NT-pro BNP was measured by enzyme-linked immunosorbent assay(ELISA).The reference interval of BNP was 0.00-125.00 pg/ml in the laboratory department of our hospital.Subsequently,the changes of plasma NT-pro BNP levels in all patients before and after operation were compared and analyzed.In addition,for the same indicators,the above groups were compared synchronously.Based on SPSS 21.0 software we have carried out statistical analysis on three groups of data,and the expression of measurement data is unified as mean(X ±s).In the process of analysis,single factor samples were analyzed by t-test,and the comparative analysis between single factor samples was carried out by rank sum test of two independentnon-parametric samples.The P values obtained in the study were all bilateral tests.The critical value of P was 0.05,which was significant when it was less than 0.05.Result: 1.The ventricular pacing ratio of the three groups was ≥85%,and there was no statistical significance(P>0.05).2.NT-pro BNP level determination: right ventricular apical pacing group was 1120.54±1587.11 pg/ml before operation,1133.15±1383.53pg/ml after operation,and non-parametric test P=0.56,indicating NT-before and after apical pacing group.There was no significant difference in pro BNP level;non-selective His bundle pacing group was 1498.21±1308.38 pg/ml before operation,and 684.03±874.43pg/ml after operation.The decrease was significant.The nonparametric test showed P=0.001,indicating non-selection.The level of NT-pro BNP was significantly different before and after the operation of the His bundle of pacing;the left bundle pacing group was 2226.44 ± 6214.19pg/ml before operation,1243.52 ± 3377.48pg/ml after operation,and the NT-pro BNP level was slightly Decreased by non-parametric test P=0.001,indicating a significant difference in NT-pro BNP levels before and after surgery in the left bundle pacing group.By comparing the results of the analysis between groups,we can see that the plasma NT-pro BNP levels of non-selective His bundle pacing group and left bundle branch pacing group showed a decreasing trend compared with right ventricular apex pacing group at 7 days after operation,which had obvious statistical significance(P<0.01).However,under the condition of comparing plasma NT-pro BNP level,there was no significant difference between non-selective His bundle pacing group and left bundle branch pacing group(P>0.05).Conclusion: Non-selective His bundle pacing and left bundle branch pacing can significantly reduce perioperative plasma NT-pro BNP levels,which is closer to physiological pacing and is beneficial toimprove patients’ cardiac function;Therefore,Non-selective His bundle pacing or left bundle branch pacing is an ideal choice for patients who rely heavily on ventricular pacing.For patients with left ventricular ejection>40% or left ventricular end-diastolic diameter <60 mm,the right ventricular apical pacing did not significantly reduce NT-pro BNP levels during the perioperative period. |
PDF Full Text Request