Influence Of Ventricular Synchrony And Cardiac Function In Patients With Different Right Ventricular Site Pacing By Echocardiography

Objective:Using different echocardiographic technology combined with Pacemaker electrode Parameters comprehensively evaluate the influence of left ventricular synchronicity and cardiac function in Patients with right ventricular apex(RVA) Pacing and septal(RVS) Pacing and further confirm the superiority of right ventricular septal(RVS) Pacing.Methods:87 Patients with Pacemaker dependent(38 cases of RVA, 49 cases of RVS) in Preoperative, 6 months after operation, Postoperative 12 months be adopted follow-up study. Through standard 12-lead electrocardiogram measurement of QRS wave width, and using conventional two-dimensional ultrasound(LVEF and LVEDD, LVESD, LVEDV, LVESV, LA diameter and SPWMD), Pulse doppler(APEI-PPEI and Aortic VTI, E/VP, E/A), tissue doppler(Tei index) and tissue synchronization imaging(Ts-diff, Ts-SD) and three-dimensional speckle tracking(GLS) technology were determined RVA and RVS group of cardiac systolic and diastolic function and left ventricular synchronicity, between groups and respectively groups and within groups comparative analysis was to investigate the right ventricular septum and right ventricular apex before and after the Pacemaker implantation echocardiographic indices of whether there are differences, in order to further confirm the right ventricular septal Pacing is superior to right ventricular apical Pacing.Results: Two sets of cardiac resynchronization Pacing site does not exist significant differences in baseline information; compared with the Preoperative, intraoperative RVA and RVS group were widened QRS wave group(P <0.05), compared with the surgery group RVS, RVA widened QRS wave group(P <0.05); compared with surgery, won by the threshold, electrode impedance after 6 months, 12 months, there was no statistically significant RVA group and RVS group; RVA group LAD after 6 months compared with the Preoperative increase after 12 months, LVEF, Simpson method EF, E / VP have decreased compared with the Preoperative(P <0.05), LAD, LVEDV, LVESV, Tei index, E / a, E / E ’, compared with that before Aortic VTI were increased(P <0.05), RVS group after 6 months, 12 months, E / a, before the E / VP decreased compared with the Preoperative(P <0.05); RVA group after 6 months, 12 months, compared with the Preoperative SPWMD increase after 12 months compared with the Preoperative APEI-PPEI increase; compared to 12 months after RVS group, SPWMD RVA group increased; compared to after 6 months, 12 months RVS group, RVA group APEI-PPEI were increased(P <0.05). RVA group GLPS-AVG, GLPS-LAX at 6 months after surgery, compared with surgery 12 months ago to reduce, GLPS-A4 C in less Postoperative 12 months ago to reduce the difference was statistically significant(P <0.05).Conclusions: 1) After Permanent Pacemaker implantation in RVA and RVS,the systolic and diastolic function and synchronization adversely be affected, but RVS Pacing compared with RVA Pacing less affected; 2) The long-term follow-up observation, RVS Pacing although the Presence of cardiac synchrony certain influence, but it still has a good wall synchronization,and follow-up does not Progress, but some Progress at the apex. 3)Tri-Plane tissue synchronization imaging and three-dimensional speckle tracking technology has good sensitivity in the evaluation of left ventricular systolic synchrony aspect.