Follow-up Investigation Of Different Right Ventricular Site Pacing On Bradyarrhythmia

ObjectiveFollow-up observation of the differences of hemodymic effects and complications in bradyarrhythmia patients with different pacing sites such as right ventricular apical, high septum and low septum pacing.MethodContinuous choose421bradyarrhythmia patients with double chamber pacemaker implantation between April2007and March2012in first affiliated hospital of Zhengzhou university. Remove patients with pacing proportion less than40%and select340cases after screening.56cases for group A of right ventricular apical pacing,27cases for male,29cases for female;132cases for group B of high septum pacing,64cases for male,68cases for female;152cases for group C of low septum pacing,77cases for male,75cases for female. Observe left ventricular ejection fraction(LVEF), left ventricular end-diastolic diameter(LVEDD),duration of QRS wave(QRSd) of three groups after a follow-up for at least12months and the changement from baseline to the end of follow-up (ΔLVEF、ΔLVEDD、ΔQRSd) and the occurrence of pacemaker implantation complications of three groups.Result(1) There was no statistical difference of baseline characteristics (gender, age, sex ratio, basic diseases and so on) among three groups (P>0.05).(2) There was no statistical difference of pacemaker indications among three groups (P＞0.05).(3) There was no statistical difference of postoperative pacemaker electrode parameters among three groups (P>0.05).(4) Comparing with different pacing sites, there was no statistical difference of preoperative ultrasonic parameter among three groups (P>0.05). The LVEF at the end of the follow-up was significantly lower than the preoperative one and LVEDD was significantly increased in group A (P<0.05). The LVEF lower and LVEDD higher can also be seen in group B and group C, but there wus no statistical difference between the preoperative parameter and the one at the end of follow-up (P>0.05). There was no statistical difference of ALVEF and ΔLVEDD between group B and group C (P>0.05), however, the ΔLVEF was significantly lower and the ΔLVEDD was significantly higher when they respectively compare with group A (P＜0.05).(5) The QRS duration of group B was shortest and the one of group A was longest with significant statistical difference after at least12months follow-up (P<0.05).(6) The common complications related to operation were blood effusion and hematoma formation in pocket(n=10,2.94%),pocket infection(n=8,2.35%),lead dislodgement(n=7.2.06%).Occurrence of blood effusion was related to old age and aspirin administration. The reasons of pocket infection were considered as that original pocket’s shape or size does not fit well with later pacemaker which caused the skin ischemia, and lead to the pocket skin rapture and infection. Dislodgement of the pacing leads was related the uncompleted ligation due to the slide ligature made by the operateor. There was no statistical difference of complication occurrence among three groups(P＞0.05).ConclusionRight ventuicular septum pacing can obviously improve the long-term effects of cardiac function. The electric and ventricular wall movement synchronization is best in right ventuicular high septum pacing and do not increase complications. Appropriate measures could be taken to avoid these complications.