ABSTRACT
Objective To evaluate the effects of pacing in right ventricular septum (RVS) on hemodynamics among atrioventricular sequential dual chamber pacing Methods Twenty patients with high grade or complete atrioventricular block received permanent dual chamber pacemaker ( DDD ),were randomized into right ventricular septum pacing group (RVS)and right ventricular apex pacing group (RVA)according to the ventricular leads position.The QRS duration of the ECG,the left ventricular ejection (LVEF),the interventricular mechanical delay( IVMD )and the plasma levels of brain natriuretic peptide (BNP)were compared before and after operations.Results Compared with the preoperation,the mean QRS duration ( ( 187.00 ± 15.67 ) ms and (94.00 ±9.17 ) ms),the IV MD ( (43.20 ± 6.79 ) ms and ( 15.00 ± 4.08 ) ms ),the level of BNP ( ( 89.70 ± 8.30) ng/L and (40.00 ± 4.73 ) ng/L) increased( P ＜ 0.05 ) and LVEF decreased significantly ( (53.70 ± 1.34) % and (58.60 ±1.65 )% ,P ＜ 0.05 ) in RVA group,but didn't change in RVS group (P ＞ 0.05 ).After three months following up,the mean QRS duration and the IVMD in RVS group( (119.00 ±7.38 )ms,(19.00 ±4.59)ms) were shorter than that of RVA group( ( 187.00 ± 15.67) ms,(43.20 ± 6.79) ms) ( P ＜ 0.05 ),the LVEF was higher and the plasma level of BNP was lower than that of RVA group ( (57.00 ± 2.00) % and ( 53.70 ± 1.34) %,(44.20 ± 9.18 ) ng/Land ( 89.70 ±8.30) ng/L,P ＜0.05).Conclusions The RVS pacing could keep the normal ventricular activation sequence and biventricular contraction synchrony farthest without side effects on hemodynamics in comparison with the RVA pacing.The RVS pacing is more approaching physiological rhythm than the RVA pacing.
ABSTRACT
Objective To investigate the electrocardiographic characteristics and assess the efficiency of ra-diofrequency catheter ablation(RFCA) in ventricular arrhythmia arising from the aortic sinus of Valsalva. Methods Eighteen patients(6 males and 12 females)were selected to undergo RFCA for ventficular arrhythmia originating from the left aortic sinus of Valsava. All of them were symptomatic,but without evidence of structural heart disease. Activation mapping was performed in the endocardium of the aortic sinus of Valsalva,then ablation was performed at the site with the earliest ventricular wave in endocardium electrograms. At the same time, coronary and aortic angiog-raphy were performed to assess the anatomic relationship between the ventricular tachycardia (VT)/ventricular pre-mature contraction (VPC) origin and coronary arteries and aortic valve before the RF energy delivery. Results Eighteen patients were successfully managed, with no major complications related to the procedure. VT eliminated and VPC counts on 24-hour ECG monitoring decreased significantly after the ablation[18 474(12 399,26 812)/24h vs 4 (1,7)/24 h, Wilcoxon signed-rank test, P<0.05]. During a follow-up period of 6 monthes, there was no recur-rence. Conclusions Ventricular arrhythmia arising from the aortic sinus of Valsalva has specific electrocardiograph-ic characteristics, and it can be successfully and safely treated under the guidance of activation mapping.