| PurposeThe intrinsic conduction bundle of direct pacing is the main characteristic of his bundle pacing,which is different from the traditional right ventricular apical and septal pacing.It can theoretically achieve real physiological pacing.However,the effectiveness and safety of the three pacing modes for patients after operation are still controversial.The purpose of this study was to investigate the effects of pacing at different sites of the right ventricle on pacing threshold,perception,impedance,QRS duration,cardiac function and ventricular synchronization in patients with ?°AVB.MethodFrom May 2017 to November 2018,64 patients with class I A indication were admitted to the First Affiliated Hospital of Kunming Medical University.According to baseline data before operation,right ventricular apical pacing(RVAP),right ventricular septal pacing(RVSP)and His bundle pacing(HBP)were matched according to age,gender,complications,QRS duration and color Doppler echocardiography at 1:1:1.Among them,20 were in RVAP group,22 in RVSP group and 22 in HBP group.After successful matching,we started clinical research and clinical follow-up.The pacing threshold,perception,impedance,electrocardiogram QRS wave duration,cardiac function and synchronization were compared between the three groups and within each group at the 1st and 6th month after surgery.Left ventricular systolic function(Left ventricular end-diastolic diameter LVEDD,left ventricular ejection fraction LVEF,aortic valvula velocity time integral AVVTI),left ventricular diastolic function(E/A,E/E')was evaluated by cardiac ultrasound.The E peak indicates the early diastolic velocity of mitral valve,the peak A indicates the late diastolic velocity of mitral valve,the peak E' indicates the early diastolic velocity of mitral annulus,and the degree of cardiac synchronization(atrioventricular synchronization(E+A)/RR).E+A indicates the time from the beginning of E peak to the end of A peak;Interventricular synchronous IVMD(APEI-PPEI),that is,interventricular mechanical delay,APEI for aortic ejection time,PPEI for pulmonary artery ejection time;Ts-SD12 indicates left ventricular synchronization,for The standard deviation of Ts of 12LV).To clarify the effects of different implantation sites of right ventricular electrodes on cardiac function,biventricular and left ventricular synchronization among three groups and within each group.The SPSS22.0 statistical software package was used to analyze the data,and the difference was statistically significant when P<0.05.Result1.In the study,the average follow-up duration was 5.5±1.0(months).RVAP,RVSP and HBP were implanted in 20 cases,22 cases and 22 cases respective-ly.The patients were followed up for 1 month and 6 months after operation.?Compared with the duration of electrocardiogram QRS wave before and afteroperation in each group:RVAP group(172.1±14.23ms vs 107.05±12.9ms,P<0.001);RVSP group(159.14±6.28ms vs 106.09±11.38ms,P<0.001);HBP group(109.86 ±5.05ms vs 108.09±7.74ms,P=0.584).?Postoperative QRS wave duration a-mong three groups:RVAP group vs RVSP group(172.1 ± 14.23ms vs 159.14±6.28ms,P=0.001);RVAP group vs HBP group(172.1±14.23ms vs 109.86±5.05ms,P<0.001);Compared HBP group with RVSP group(159.14±6.28ms vs 109.86±5.05ms,P<0.001).2.There were no significant changes in pacing threshold and perception among the three groups after surgery,or compared after surgery with before surgery(P>0.05).Postoperative impedance among three groups:RVAP group vs RVSPgroup(549.25±130.72? vs 713.64±155.8Q,P=0.011),RVSP group vs HBP group(713.64±155.8? vs 618.68±127.41?,P=0.966),RVAP group vs HBP group(549.25±130.72? vs 618.68±127.41?,P=0.111),the difference between the former group was significant.Postoperative impedance and intraoperative comparison among three groups:RVAP group(549.25±130.72± vs 659.75±138.84 Q,P=0.007),RVS P group(713.64±155.8? vs 547.45±155.24?,P<0.001),HBP group(618.68±127.41? vs 508.55±126.9?,P=0.004).The difference was statistically significant.3.The indexes of left ventricular systolic,diastolic function and atrioventricular synchrony were evaluated in the three groups after surgery,and there was no significant difference between the three groups(P>0.05),The difference was not statistically significant.4.The evaluation of inter-ventricular synchrony index IVMD was significantly longer in the RVAP group than before surgery(39.4±8.43ms vs 23.14±8.43ms,P<0.001),the difference was statistically significant.IVMD was significantly longer in RVAP group than that in the other two groups(RVAP group vs RVSP group 39.4±8.43ms vs 27.57±8.84ms,P<0.001.RVAP group vs HBP group 39.4±8.43ms vs 21.62±6.38ms,P<0.001),the difference was statistically significant.The comparison of postoperative and preoperative or between groups in the other two groups(P>0.05),the difference was not statistically significant.5.Ts-SD12,an index for evaluating left ventricular synchronization,was longer in RVAP group than before(41.46±11.50ms vs 24.70±6.60ms,P<0.001),the diffe-rence was statistically significant.There was no significant change in left ventri-cular synchronization after operation in HBP group and RSVP group(HBP gro-up 21.62±6.05ms vs 24.44±6.82ms,P=0.160;RVSP group 30.44±6.22ms vs 23.96±6.28ms,P=0.065),the difference was not statistically significant.The intra-left ventricular synchronization was different among the three groups after operation.(RVAP group vs RVSP group 41.46±11.5ms vs 30.44±6.22ms,P=0.002;RVAPgroup vs HBP group 41.46±11.5ms vs 21.62±6.05ms,P<0.001;RVSP group vs HBP group 30.44±6.22ms vs 21.62±6.05ms,P=0.025),the difference was statistic-ally significant.6.The correlation scatter plot of QRS wave with IVMD and QRS wave with Ts-SD12 after operation in three group:QRS wave was positively correlated with IVMD(r=0.577,P<0.001).The difference was statistically significant.There was a significant positive correlation between QRS wave and Ts-SD12(r=0.588,P<0.001).The difference was statistically significant.Conclusion1.Postoperative QRS duration was positively correlated with IVMD and Ts-SD12,respectively.2.Compared with RVAP and RVSP,HBP can better maintain interventricular and left ventricular synchronization. |
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