Clinical Research Of Hemodynamic Effects On The Heart With DDD Atrioventricular Sequential Pacing And Atrio-ventricular Delay Autonomic Rhythm

Objectives：To the same patients with dual-chamber pacing, Compareatrioventricular sequential pacemaker and independent rhythm of the heartwith atrioventricular delay to the influence of blood flow dynamics, Providingguidance for pacemaker SPC.Material and Methods:1.Study object:Patients with dual-chamber pacing implanting orreplacing for sick sinus syndrome or atrioventricular block and placement orreplace permanent from2010-2012in our hospital; Screening independentrhythm of the heart with atrioventricular delay with SPC instrument (namelyatrioventricular block patients with I degree).2. Research methods:2.1In the selected object, if patient is in independent rhythm of the heartwith atrioventricular delay, AV interval will be programmed in300ms withSPC instrument, measuring stroke output (SV), cardiac output (CO), fractionshortening (FS)、the left ventricular ejection fraction (LVEF),pulmonary valveblood flow velocity (PV)、aortic valve blood flow velocity (AV)、tricuspidvalve blood flow velocity A-peak and E-peak (TV-A, TV-E), mitral valveblood flow velocity A-peak and E-peak (MV-A, MV-E)with colormultispectral le heart ultrasonic instrument;2.2The above measurement is over,and AV interval (PAV170ms, SAV150ms) will be programmed to ensure the atrioventricular sequentialpacing with the same pulse width and output voltage for the same patients2.3After programming,patients need to take a break in bed for fiveminutes to stable hemodynamics, measuring SV、CO、FS、LVEF、PV、AV、TV–A、TV–E、MV–A、MV-E)with color multispectral le heart ultrasonicinstrument by the same doctor.3. Statistical analysis:Inputing data in excel2003,establishing database with SPSS13.0statistical software packages, adopting mean±standard deviation(x±S）formeasurement data, using percentage for count data, Using paired t test fornormal distribution data, using rank and sum test for the normaldistribution data, the difference is significant for p <0.05.Results:1.In patients with normal cardiac function, compared withatrioventricular sequential pacing, atrioventricular delay autonomic rhythmhas Slightly increased, but there was no statistically significant difference inCO、FS、LVEF、PA、AV、TV-A、TV-E、MV-A、MV-E2. In patients with normal cardiac function, compared withatrioventricular sequential pacing, atrioventricular delay autonomic rhythmhas increased significantly and the difference was statistically significant inSV、CO、LVEF、PA、AV、TV-A、TV-E、MV-A、MV-EConclusions：1． In patients with normal cardiac function, compared withatrioventricular sequential pacing, atrioventricular delay autonomic rhythmhas slightly increased, but there was no statistically significant difference in CO、FS、 LVEF、PA、AV、TV-A、TV-E、MV-A、MV-E.At this point, weshould pursuit minimizing ventricular pacing and reduce proportion of rightventricular pacing；2． In patients with normal cardiac function, compared withatrioventricular sequential pacing, atrioventricular delay autonomic rhythmhas increased significantly and the difference was statistically significant inSV、CO、LVEF、AV、TV-A、MV-A. At this point, we should progamatrioventricular sequential pacing mode with pacemaker SPC.After waitingfor patients with hemodynamic improvement, we should pursuit minimizingventricular pacing again and reduce proportion of right ventricular pacing.