摘要目的 评价右心室起搏导线位置对心脏再同步治疗(CRT)效果的影响.方法 71例顽固性心力衰竭患者接受CRT手术,53例左心室导线植入侧壁或侧后壁,18例植入前壁或下壁(非侧后壁)；48例右心室导线植入心尖部,23例植入流出道间隔部.术前记录受试者心功能(NYHA分级)、QRS时限(QRSd)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)及左心室收缩末期内径(LVESD)；术后6个月对上述参数进行随访,比较不同右心室起搏部位对CRT临床疗效的影响.结果 术后6个月,右心室心尖部起搏组LVEF高于流出道间隔部起搏组[(0.44±0.07)对(0.40±0.07),P=0.048],余心功能、QRSd、LVEDD、LVESD等各项指标均差异无统计学意义(P＞0.05).根据左心室起搏部位进一步分为侧壁或侧后壁与非侧后壁两组,就侧壁或侧后壁组,右心室心尖部起搏较间隔部起搏可更好地提高心输出量LVEF[(0.45±0.07)对(0.40±0.08),P=0.027],改善心功能[(2.59±0.59)对(3.00±0.68),P=0.038],对于非侧后壁组,比较右心室心尖部与流出道间隔部起搏,各项指标均差异无统计学意义(P＞0.05).结论 若无视左心室起搏部位,右心室心尖部起搏略优于流出道间隔部起搏；而对于左心室侧壁和/或侧后壁起搏者,应尽量将右心室导线置于心尖部,以获得较好疗效.

abstractsObjective Toevaluate the effect of right ventricular(RV) lead location on clinical response to cardiac resynchronization therapy(CRT).Methods A total of 71 patients with refractory heart failure received CRT,among whom 53 subjects had a laterally or posterolaterally positioned left ventricular(LV) lead;another 18 subjects had the LV lead inferiorly or anteriorly(non-posterolaterally) positioned.As for the RV lead,48 cases placed at apex(RVA) while the other 23 placed at outflow tract septum (RVOT septum).Before and 6 months after implantation,NYHA functional class,QRS duration (QRSd) of electrocardiogram and echocardiographic parameters including LV ejection fraction (LVEF),LV end-diastolic diameter (LVEDD) and LV endsystolic diameter(LVESD)were recorded in all the subjects.A comparison was made according to different RV pacing sites.Results At 6-month follow-up,RVA pacing had only a slightly higher LVEF than that RVOT pacing[(0.44±0.07) vs(0.40±0.07) P=0.048].Except for that,no other differences could be seen between these two groups(P＞0.05).When we separately assessed the significance of RV pacing site in different LVstimulation sites,the RVA pacing was associated with higher LVEF [(0.45 ± 0.07) vs (0.40 ± 0.08),P =0.027] and better NYHA class improvement[(2.59±0.59) vs (3.00±0.68),p =0.038] compared with RVOT septum site when the LV stimulation site was lateral or posterolateral vein.However,there were no significant differences in terms of clinical improvement,QRSd and echocardiography with a non-posterolaterally positioned LV lead (P＞0.05).Conclusion RVA pacing was only a bit superior to RVOT pacing following CRT,irrespective of LV pacing site.If the LV lead was located at lateral or posterolateral vein,we recommend an RVA pacing site in order to get a better response.