| Objective:To evaluate the effects of the right ventricular apex (RVA) Pacing and right ventricular septal (RVS) pacing to the myocardial remodeling,left ventricular systolic function and hemodynamics; To evaluate the expression of the N-terminal pro-brain natriuretic peptide (NT-proBNP) in the RVA and RVS pacing; To evaluate the relevance between the NT-proBNP levels and myocardial remodeling,left ventricular systolic function and hemodynamic changes in patients with pacemakers, for the evaluation of the best pacing site, select the the best time for the patients to replace or up grade the pacemakers and provide the evidence for patients to recept anti-heart failure therapy in the early time.Methods:Randomly selected 96 cases recepted the therapy of permanent pacemakes in our hospital during December 2007 to August 2009, following time is January 2008 to March 2010, according to the selection criteria,63 cases was selected finally and follow-up for 18.11±5.71 months。According to the different pacing sites,63 cases were divided into two groups, one group wasPacing in the RVA (27 cases), another group was pacing in the RVS (36 cases)。The age,follow-up time,pacing mode,sex ratio and cardiac function classification had no statistically significant difference in two groups, the composition of the hypertension,atrial fibrillation,diabetes and coronary heart disease in patients had no statistically significant difference, the sick sinus syndrome and III degree atrioventricular block in patients had no statistically significant difference (Table 2-1 and Table 2-2)。The two groups of patients recepted echocardiography inspection inPreoperative, with an average follow-up time of 18.11±5.71 months, recepted echocardiography inspection again and tested the level of the NT-proBNP。Excluding criteria:cardiac resynchronization therapy (CRT), implantable cardioverter defibrillator devices (ICD), myocardial infarction (MI), dilated cardiomyopathy (DCM), valvular disease, anemia and renal dysfunction patients。Results:63 cases were followed up for 18.11±5.71 months, results showed that:(1) RVA pacing group:the left ventricular end-diastolic diameter (LVEDD) increased significantly (46.46±7.80 mm vs 49.04±9.67 mm, P<0.01), the right atrium (RA) expanded significantly (29.85±5.49 mm vs 31.37±6.35 mm, P <0.01), the right ventricle (RV) expanded significantly (27.44±3.27 mm vs 29.41±4.81 mm, P<0.01), the interventricular septum thickness (IVST) was thicker significantly (9.79±0.90 mm vs 10.16±1.07mm, P<0.05), the left ventricular posterior wall thickness (LVPWT) was thicker significantly (9.50±1.14 mm vs 10.34±1.27 mm, P < 0.01), the left ventricular ejection fraction (LVEF) decreased significantly (60.44±10.43 mm vs 53.70±12.20 mm, P<0.01), the left ventricular fraction shortening (FS) decreased significantly (31.59±6.22 mm vs 29.26±7.73 mm, P<0.05), AMV increased significantly (1.30±1.07 cm2 vs 2.17±0.99 cm2, P<0.01), ATV increased significantly (1.63±0.68 cm2 vs 2.42±1.50 cm2, P<0.01), the left atrium (LA) had no significant difference (P=0.09)。(2)RVS pacing group:the LVEDD reduced significantly (46.50±6.66 mm vs 44.81±6.70 mm, P <0.05), the LVEF increased significantly(61.19±8.83 mm vs 63.69±6.97 mm, P<0.05), AMV significantly reduced(1.28±0.86 cm2 vs 0.89±0.79 cm2, P<0.01), LA,RA. RV,FS,IVST,LVPWT and the ATV had no significant differences (P>0.05)。(3) Compared with the RVS pacing group, the LA equation in RVA pacing group increased significantly (P<0.05), the LVEDD increased significantly (P< 0.01), the RA increased significantly (P<0.05), the RV increased significantly(P< 0.01), the LVEF was lower significantly (P<0.01), the FS was lower significantly (P<0.05), the AMV and ATV increased significantly (P<0.01)。Follow-up for 18.11±5.71 months, the NT-proBNP level of the RVA pacing group was increased significantly than RVS pacing group (342.84±186.54 mm vs 583.83±240.15 mm, P<0.01)。(4) The NT-proBNP levels was positively correlated with LA (r=0.51, P<0.01), was positively correlated with LVEDD (r=0.82, P<0.01), was positively correlated with RA (r=0.45, P<0.01), was positively correlated with RV (r=0.27, P<0.05), was negatively correlated with LVEF (r=-0.60, P<0.01), was negatively correlated with FS (r=-0.55, P<0.01), was positively correlated with AMV (r=0.29, P<0.05), and was positively correlated with ATV (r=0.33, P<0.01)。Conclusion:The RVS pacing was superior to the RVA pacing, it could significantly reduce the effects of the hemodynamics,improve cardiac function and reduce myocardial remodeling。The NT-proBNP levels was correlated with myocardial remodeling and left ventricular function, the worse of the myocardial remodeling,the left ventricular systolic function and the reflux, the higher of the NT-proBNP levels。NT-proBNP could be used as an indicator for selecting the best pacing in the clinic, guiding the clinical to replace,upgrade the pacemakers in the best time and recept the therapy of anti-heart failure in time。...
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