心室起搏管理模式（MVP）对右心室流出道间隔部起搏患者心功能影响.docVIP

双腔起搏器最小化心室起搏策略对心衰患者心功能的影响 摘要 目的：比较自动房室搜索（Search AV）和心室起搏管理（managed ventricular pacing，MVP）模式下，双腔起搏器植入的心衰患者其心功能变化情况。方法：选取58例因病态窦房结综合征植入双腔起搏器的患者，采用右心室流出道起搏方式，随机分为Search AV组和MVP组，植入起搏器后分别启用Search AV模式和MVP模式，随访12个月，比较两组心室起搏比例差异以及术前及术后12个月心功能指标和血浆NT-ProBNP水平差异。结果：MVP组心室起搏比例较Search AV组心室起搏比例明显减少（0.5% vs 4.2%，P 0.01）；Search AV组左室射血分数术后下降、E/A比值下降，而MVP组射血分数及E/A比值的变化没有统计学意义。两组患者术后12个月NT-ProBNP较术前均有所增加，SearchAV组较MVP组增加更为明显（456pg/ml vs 258pg/ml，P＜0.05）。结论：对于病态窦房结综合征植入双腔起搏器的心衰患者，右心室流出道起搏状态下，MVP模式较Search AV模式对患者长期的心脏收缩和舒张功能影响较小。 关键词 心室起搏管理 自动房室搜索 心力衰竭 心脏功能 Impacts of different strategies to minimizing ventricular pacing on patients with heart failure Abstract Objective：To evaluate cardiac function changes in patients of heart failure, who received dual chamber pacemaker implantation between two algorithms: managed ventricular pacing(MVP) and search atria ventricle(Search AV) because of sick sinus syndrome. Methods： A total of 58 patients received permanent dual chamber pacemaker for sick sinus syndrome were divided into MVP group and Search AV group randomly. Managed ventricular pacing or search atria ventricle algorithms were used accordingly after the pacemaker were implanted. The percentages of ventricular pacing，index of echocardiography and plasma NT-ProBNP were recorded before the operations and after 12 months follow-up. Results: The percentages of ventricular pacing was lower in MVP group than in Search AV group（0.5% vs 4.2%，P 0.01）.The LVEF falled and the E/A ratio decreased in the Search AV group after 12 months follow-up, yet the MVP group had no statistically significant changes. The plasma NT-ProBNP increased in both groups and the Search AV group increased more（456pg/ml vs 258pg/ml，P＜0.05）. Conclusion: MVP algorithm has less influence than Search AV algorithm on the patients’heart systolic and diastolic functions, who had heart failure and received dual chamber pacemaker implantation because of sick sinus syndrome. Key words： managed ventricular pacing；