| PurposeExplore coronary sinus hitches in normal cardiac pacemaker implantation ventricular pacing, the necessity and feasibility of replacement of traditional right ventricular pacing has provided the new mentality for cardiac pacemaker technology improvements and basis.Method1. Selection in November2012to November2013were admitted the first clinical college of Kunming medical university, in line with the ACC/AHA guidelines, a total of61patients with pacemaker I class indication. There were31males and30females, the average age was63.60±12.17years.61patients were randomly divided into the traditional right ventricular (locating the right ventricular apex or interval lower) pacing group (32cases) and coronary sinus pacing group (29cases). And the coronary sinus ventricular pacing, turning traditional right ventricular pacing in patients with surgery failure.2. To compare the safety, feasibility of two groups of pacing method; Observation indexes include ventricular electrode implantation was required X-ray exposure time, pacing parameters in January, March, immediately, two groups before and after pacing width of QRS wave and QRS width compared between the two groups; Success rate of surgery immediately, preoperative and postoperative one month, three months the two groups of heart colour to exceed to measure right ventricular end-diastolic diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction and tricuspid regurgitation in rates were compared between groups and their own comparison before and after. 3. Using statistical software SPSS17.0to analyze data to P<0.05out differences significantly.Result1. Via coronary sinus ventricular pacing group of29cases of surgical immediate19cases,10cases of failure, success rate of65.52%;8cases in2cases of normal wing ventricular electrode has been applied successfully, the success rate of25%;21cases of application of the coronary sinus special ventricular pacing electrodes, immediate surgery of17cases of success, success rate of80.95%. The coronary sinus special ventricular electrode the success rate is higher than the ordinary of ventricular electrode (80.95%versus25%, P=0.009).2. Traditional right ventricular pacing group of32cases of surgery all immediate success, success rate of100%. Via the coronary sinus of ventricular pacing, power less than traditional right ventricular pacing group (65.52%and100%, P=0.001).3. Regularly coronary sinus surgery group ventricular pacing threshold (1.43±1.05v and1.05±0.69v, P=0.009) value is higher than traditional right ventricular pacing threshold, feel (10.77±4.96mv and9.66±2.93mv, P=0.367) no statistical difference, the impedance (884.35±476.52Ω and615.48±214.89Ω, P=0.010) is higher than the traditional right ventricular pacing group; one after menstruation coro-nary sinus group ventricular pacing threshold(1.16±0.76v and0.83±1.01lv, P<0.05) was slightly higher than that of traditional right ventricular pacing, feel12.85±6.41mv and11.21±7.10mv, P=0.449) no difference, slightly higher than that of traditional right ventricular pacing impedance(737.18±251.19Ω and555.13±185.23Ω,P=0.006); Postoperative three menstrual coronary sinus ventricular pacing group slightly higher than traditional right ventricular pacing threshold (1.12±0.76v and0.66±0.28v, P=0.004), no differences in perception(13.67±6.25mv and12.74±7.73mv, P=0.684), impedance (758.18±217.22Ωand540.42±179.99Ω, P=0.001) was slightly higher than that of traditional right ventricular pacing group; Intraoperative and postoperative one month, three menstrual coronary sinus ventricular pacing threshold, there is a ownturn in the impedance perception has a rising trend but there were no statistical ignificance (P values are:0.449,0.361,0.275); Traditional right ventricular pacing threshold, perception, impedance also no significant change (P values are:0.613,0.234,0.286).4. Traditional right ventricular pacing group of preoperative QRS duration (106.59±22.78ms), postoperative march QRS duration (121.31±41.50ms); Preo-perative QRS via coronary sinus ventricular pacing group (113.44±35.24ms), postoperative march QRS duration (136.59±38.48ms). Compared with the preo-perative, postoperative electrocardiographic QRS duration two group were increased, the traditional right ventricular pacing group influence on QRS duration (P=0.020); The coronary sinus ventricular pacing group (P=0.044) influence on QRS duration.5. Via the coronary sinus surgery in patients with ventricular pacing group before and after the QRS wave time difference (34.06±29.96) and the traditional right ventricular pacing group of patients before and after surgery QRS wave time difference (55.28±32.50), with narrow QRS wave influence degree between the two groups differences (P<0.05).6. Traditional right ventricular pacing group ventricular electrode implanted X-ray exposure time and the coronary sinus ventricular pacing group had statistically significant difference (193.50±110.25s and445.50±452.75s, P<0.001).7. Traditional right ventricular pacing, postoperative LVEF group (60.38±6.89) compared with preoperative reduced LVEF (64.19±9.89), there was a significant statistical difference (P=0.020); Via coronary sinus ventricular pacing, postoperative LVEF group (62.29±10.74) compared with preoperative LVEF (59.50±14.12), no statistical difference (P=0.345). Traditional right ventricular pacing group of tricuspid regurgitation in postoperative area (1.23±1.72cm2) compared with preo-perative tricuspid regurgitation (0.11±0.62cm) increased, there are statistically significant differences (P=0.001); Via the coronary sinus postoperative tricuspid regurgitation in area of ventricular pacing group (1.08±1.81cm2) compared with preoperative tricuspid regurgitation in area (0.24±0.71cm2), no statistical difference (P=0.105).Conclusion1. Via the coronary sinus ventricular pacing, compared with traditional right ven-tricular pacing, via the coronary sinus ventricular pacing, high technical difficulty, intraoperative radiation exposure time is long, the success rate is relatively low.2. Via the coronary sinus ventricular pacing QRS wave width than traditional right ventricular pacing, narrow, that the former ventricular synchronicity.3.Via the coronary sinus ventricular pacing has no influence tricuspid regurgi-tation. Traditional right ventricular pacing, increase the tricuspid regurgitation.4. Early observation via coronary sinus ventricular pacing on cardiac function improved significantly better than that of the traditional right ventricular pacing.5. Via the coronary sinus ventricular pacing, operation difficulty is high, but the basic feasible. Of tricuspid regurgitation, poor heart function, and patients with wide QRS wave is preferred by the coronary sinus ventricular pacing.6. The coronary sinus electrode can significantly improve the success rate of special... |
PDF Full Text Request