| Objective:Artificial cardiac pacemaker device as a treatment for patients with cardiac conduction dysfunction has been well known,and with the development of technology,the current pacemaker equipment function has been improved and strengthened to meet the needs of different patients and to achieve physical pacing.However,the right ventricular apex pacing has a detrimental effect on hemodynamics is an indisputable fact,so people begin to search how to let the pacemaker implantation patients to achieve physiological pacing.In recent years,we are not only constantly looking for a more suitable pacing site and research to reduce the proportion of right ventricular pacing,but also by comparing the right ventricular septal and apical pacing's short-term and long-term effects on cardiac structure and function to prove the right septal ventricular pacing can benefit patients,but the results are unsatisfactory.At the same time with the patients who implanted pacemaker increase gradually,most patients' body function has been improved,but there are some patients can not adapt to the pacemaker after the implantation,meanwhile pacemaker as a stress can also affect the patient's mental health and normal daily life,and in order to improve the prognosis of these patients,it requires clinicians to be able to identify and take early intervention.Methods: After screening,62 patients with VVI(R)or DDD(R)models permanent pacemaker were enrolled in January 2014 to January 2016,according to the plantation site of right ventricular pacing electrodes,we divided all the patients into right ventricular apex pacing group and right ventricular septal pacing group.Before the operation we collected patients' general condition and medical history.The patients were examined with electrocardiogram and cardiac ultrasonography before and 12 months after the operation.The threshold,sensory and impedance of patients' pacemaker were collected on the day of surgery and 3 months after the operation.And after 3 months of operation we needed to collect the percentage of ventricular pacing and the events that the pacemaker recorded.Then we assisted patients to complete the Pittsburgh sleep quality index,the quality of life enjoyment and satisfaction questionnaire and Hamilton anxiety and depression scale before the operation,after 1 week and 3 months of the operation.Finally,the effects of different pacing implantation sites on sleep quality,quality of life and satisfaction and cardiac structure and function were evaluated.Results: All patients who met the criteria for inclusion were generally collected the medical history,the parameters of the pacemaker on the day of plantation,1 week and 3 months after the operation.All the scores of the scales,the electrocardiograph and echocardiography date were gathered before the operation,1 week and 3 months after the operation.1 The two groups of patients' Pittsburgh sleep quality index score showed that: there was no statistical difference between the right ventricular apex pacing group and right ventricular septal pacing group before the operation,1 week and 3 months after the operation,but the Pittsburgh sleep quality index score was significantly higher in the two groups after 1 week and 3 months of the operation,and the Pittsburgh sleep quality index score was higher at 1 week after operation than the Pittsburgh sleep quality index score at 3 months after the operation.There was no statistical differences in the score of the two groups before the operation.There were statistical differences in subjective sleep quality scores and daytime functional scores between the two groups at 1 week and 3 months after operation.Right ventricular septal pacing group subjective sleep quality score,day function score was higher than the right ventricular apex pacing group.2 The quality of life enjoyment and satisfaction questionnaire results showed that there was no statistical difference in the quality of life and satisfaction between two groups before and after the operation.But The quality of life enjoyment and satisfaction questionnaire scores of two groups were higher than before.3 Results of sleep-related factors in patients after pacemaker implantation showed that the sleep quality score was correlated with patients' hospitalization time,anxiety and depression scores,and the 3-month sleep quality score and pacemaker programmer recorded cardiac events(atrial fibrillation,pacemaker-mediated tachycardia,ventricular premature contraction,atrial tachycardia,ventricular tachycardia),anxiety and depression scores.4 The ECG and cardiac color doppler ultrasonography in the two groups showed that there was no statistical difference in QRS duration between the two groups before and after operation.The QRS duration of the two groups was longer than that before the operation.And the right ventricular apex pacing group was significantly longer than the right ventricular septal pacing group.Left atrial diameter,left ventricular end diastolic diameter,left ventricular end systolic diameter and left ventricular ejection fraction were no statistical difference between the two groups,but left atrial diameter,left ventricular end diastolic diameter was higher than those in the right ventricle pacing group.5 The pacing parameters of the two groups showed that there were no statistical differences in the pacing threshold,perception and impedance on the day of operation of two groups,and the percentage of ventricular pacing in the two groups after 12 months of operation.Conclusion:Patients with short-term sleep disorders were associated with anxiety and depression after pacemaker implantation.Patients with postoperative short-term sleep disorder might be associated with hospital days,and sleep disorder after 3 months of implantation might be associated with the pacemaker recorded heart events(atrial fibrillation,pacemaker-mediated tachycardia,ventricular premature contraction,atrial tachycardia,ventricular tachycardia).Right ventricular apex pacing group and right ventricular septal pacing group had an effect on cardiac structure and function,but the effect of right ventricular septal pacing group was less than that of right ventricular apex pacing group. |
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