The Effects Of Different Right Ventricular Pacing Site To Patients With Complete Atrioventricular Block In Cardiac Construction And Function

Objective Artificial cardiac pacing is the standard treatment of patients with complete Atrioventricular Block(c AVB),and,right ventricular apex(RVA)is the conventional implanted-in position of ventricular lead,though it may hurt the function of left ventricle and trigger post-operational atrial fibrillation(AF).Previous clinical studies of non-apical pacing have come out with controversial conclusions.The aim of this trial is to evaluate whether the right ventricular septal(RVS)pacing is beneficial or not for patients with c AVB and preserved left ventricular ejection fraction(LVEF).Method It is a retrospective study and we randomly screened 60 patients with c AVB and permanent cardiac dual-chamber pacemaker implanted,who have been in the Affiliated Hospital of Qingdao University between December,2010 and December,2011,excluded patients with AF/heart failure/sinus nod diseases history.They are equally divided into 2 groups,the one is Group RVA(RVA pacing,n=30,female 14(46.7%)),the other is Group RVS(RVS pacing,n=30,female 13(43.3%)).We collected the baseline LVEF,left atrial dimension(),left ventricular end diastolic diameter(LVEDd),left ventricular end systolic diameter(LVEDs).When it gets to more than 5 years since the operation,we call the patients back for follow-up.By then,device and Echocardiographic data were collected for inter-group and inner-group contrast,including ventricular pacing percentage,LVEF,LAD,LVEDd,LVEDs.Besides,patients with new onset AF and permanent AF would be counted.Result After 5years since operation,it does have a significant difference in LAD,LVEDd and LVEDs(RVA P<0.05,RVS P<0.05).There is no significant difference in LAD between two groups(P>0.05).it does have a significant difference in LVEF decline(RVA P<0.05,RVS P<0.05)of both groups,and there is significant difference in inter-group contrast(P<0.05).There is no ignificant difference in new AF patients between two groups(P>0.05).Conclusion 1.In patients with c AVB and preserved LV function,RVA pacing provide a more detrimental effect on left ventricular function than RVS pacing over a 5-year-follow-up,while RVS pacing can decline heart failure rate.2.RVA pacing hurt the heart’s function more than RVS pacing.3.When it is in corresponding level of ventricular pacing,RVS pacing can not decrease the post-operational AFB.