The Effect Of Different Right Ventricular Pacing Sites On Cardiac Function And Arrhythmia In Pacing Patients

Objective:1.To explore the difference of pacing parameters among high ventricular septum pacing,middle ventricular septum pacing and right ventricular apex pacing.To compare the effect of different pacing sites on cardiac function.2.To analyze the incidence of arrhythmia and the duration of QRS wave in different patients with the high ventricular septum pacing,middle ventricular septum pacing or right ventricular apex pacing.Materials and Methods:1.90 pacing patients with slow arrhythmia caused by the high atria ventricular block were selected as the research subjects and divided into three groups according to the operation time sequence.Among them,there were 30 cases in high ventricular septum pacing group,30 cases in middle ventricular septum pacing group and 30 cases in right ventricular apex pacing group.Pacing parameters were compared among the three groups at the time of electrode implantation,1 month and 3 months after operation.2.The echocardiographic parameters and NT-pro-BNP content of each group were compared before operation,12 months and 24 months after operation.Cardiac parameters include left ventricular diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)3.Electrocardiogram(ECG)and dynamic electrocardiogram(DCG)were performed before operation,12 months after operation and 24 months after operation respectively in order to measure QRS wave duration and record the occurrence of arrhythmia.The incidence of arrhythmia and QRS wave duration in each group were compared.Results:1.Comparing the pacing parameters of electrodes in each group,there was no significant difference in R-wave perception,pacing threshold and electrode impedance during operation,1 month after operation and 3 months after operation(P>0.05).2.With the prolongation of the pacing time,the NT-pro-BNP content was reduced significantly in the high interventricular septum group and the middle interventricular septum group than the right ventricular apical pacing group.The LVEDD was obviously shortened and the LVEF was obviously improved in the high interventricular septum group and the middle interventricular septum group compared with the right ventricular apical pacing.The difference was statistically significant at the 24 months after operation(P<0.05).3.The electrocardiogram and dynamic electrocardiogram in patients of each group showed that,it has a shorter QRS wave duration in the high interventricular septum group and the middle interventricular septum group compared with the apical group at 12 months and 24 months after operation.With the prolongation of pacing time,the ratio of new arrhythmia in the high interventricular septum group and the middle interventricular septum group was significantly lower than that in the apex group at 24 months after operation.The difference was statistically significant(P<0.05).4.It has no significant difference between the high interventricular septum group and the middle interventricular septum group about the pacing parameters,NT-pro-BNP content,ultrasonic parameters,the occurrence of arrhythmia and the QRS duration during the follow-up period(P>0.05).Conclusion:1.It has similar pacing parameters and effective pacing sites for the clinical treatment among high ventricular septum pacing,middle ventricular septum pacing and right ventricular apex pacing.2.Compared with the right ventricular apical pacing,it has a shorter QRS wave duration and less occurrence of arrhythmia in the high ventricular septum pacing and middle ventricular septum pacing.It can reduce effect on cardiac function significantly compared with right ventricular apical pacing.