A Comparative Study On The Ultrasound Characteristics Of Coronary Sinus Ventricular Pacing With The Traditional Right Ventricular Pacing

Objectives:By Echocardiographic follow-up, collect the echocardiographic indexes of CS ventricular pacing and the traditional right ventricular endocardial pacing, including the change of heart chamber size,cardiac function, left ventricular synchrony, TR area,ex.In order to verify the feasibility and advantages of CS ventricular pacing,To provide scientific basis for its application.Method:l.During December 2012 to May 2014,50 patients in line with class I indications in 2008 ACC/AHA A/HRS "guidelines" for ordinary cardiac pacing, hospitalized in Department of Cardiology in the First Affiliated Hospital of Kunming Medical University, were continually enrolled. All cases were randomly divided into the research group of CS ventricular pacing and the traditional right ventricular pacing group, After CS pacing is not successful instead of the traditional right ventricular pacing.All patients signed informed consent form operation.2.The traditional right ventricular pacing group using right ventricular electrode.crossing the three tricuspid valve to complete to operation; the CS ventricular pacing group use normal of electrode or special CS ventricular electrode, through the CS complete the ventricle electrode implantation.3.All patients in the preoperative, postoperative 1 month, three months, half a year and one year follow-up by Echocardiography. The collection includes:cardiac chamber size, left ventricular systolic function and synchrony index, TR area.4. The SPSS20.0 statistical software package was used for data processing, and therewas a significant difference if P< 0.05.Result1.Baseline data:There was no statistically significant difference of baseline characteristics between the CS ventricular pacing group and the traditional right ventricular pacing group:32 patients underwent conventional right ventricular pacing, including male 16 cases, female 16 cases; the minimum age of 35 years old, the maximum age of 83 years old, mean age 64.47±11.40 years, of which 18 cases of sick sinus syndrome, atrioventricular block in 7 cases, second degree atrioventricular block in 7 cases.18 cases underwent the CS ventricular pacing, including male 11 cases, female 7 cases; the minimum age of 35 years old, the maximum age of 78 years old, mean age 62.22+12.95 years, of which 9 cases of sick sinus syndrome, atrioventricular block in 7 cases,2 cases of second degree atrioventricular block. There was no significant difference between the two groups at baseline (P> 0.05). All patients completed a year follow-up.LComparison within group:In the traditional right ventricular endocardia pacing group, all the observation of ultrasound parameters,including:left atrial(LA), left ventricular(LV), right atrium(RA), right ventricle(RV), interventricular septum (IVS)and left ventricular posterior wall(LVPW) thickness and the range of motion, CO, CI, left ventricular ejection(LVEF) and Left ventricular fractional shortening(FS), left ventricle at the end of diastolic volume(LVEDE), left ventricle at the end of systolic volume(LVESV),Left ventricular stroke volume (LVSV), Three tricuspid regurgitation area (TR area), standard deviation of the time to regional peak systolic velocity of the 12 left ventricular segments (TS-12-SD), pulmonary artery systolic pressure (PASP), there was no obvious change in one year follow-up (P> 0.05). But in CS pacing group, LVPW amplitude increased, the P value is less than 0.001, there was significant difference; TS-12-SD decreased gradually, P< 0.05, these was significant difference. There was no significant difference in other indexes.3.Comparison of ultrasound index between two groups:in one year of follow-up, the CS pacing in patients with LVPW range of motion, EF, FS were significantly higher than those in patients with traditional right ventricular pacing, P< 0.05, the difference was statistically significant.Conclusion1.Using the CS ventricular pacing in patients with normal cardiac pacing, the left ventricular systolic function is maintained, synchronization of the left ventricle was improved, suggesting that the CS pacing is more physiological pacing.2.The effects of TR, no significant differences between the cross three tricuspid right ventricular pacing and CS pacing, but the CS ventricular pacing on the influence degree of the TR was smaller.3. The CS ventricular pacing is safe, feasible and necessary.