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Objective To compare the effects of different right ventricular pacing sites on left ventricle systolic function in elderly patients with sick sinus syndrome (SSS).Methods A total of 78 elderly patients with SSS were selected in our hospital from 2014 to 2016,and were divided into the right ventricular apical group (RVA group,40 cases) and right ventricular outflow tract group (RVOT group,38 cases) according to sites of right ventrieular pacing.The QRS duration,accumulative total right ventricular pacing percentage and left ventricle function indicators were compared between the two groups before operation and 3,9 months after operation.Results There was no statistically significant difference in QRS duration and left ventricle function indicators before operation between the two groups (P＞0.05).The QRS durations in the RVA group at 3,9 months after operation were longer than those in the RVOT group,there were statistically significant differences (P＜0.05).No statistically significant difference was found in accumulative total right ventricular pacing percentage at 9 months after operation between the two groups (P＞ 0.05).At 9 months after operation,the left ventricular ejection fraction in the RVOT group was higher than that in the RVA group,and the left ventricular end diastolic diameter was lower than that in the RVA group,there were statistically significant differences (P＜0.05).Conclusion The effects of RVOT pacing on left ventricle systolic function in elderly patients with SSS is superior to the RVA pacing.
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Objective To compare the effects of different right ventricular pacing sites on left ventricle systolic function in elderly patients with sick sinus syndrome (SSS).Methods A total of 78 elderly patients with SSS were selected in our hospital from 2014 to 2016,and were divided into the right ventricular apical group (RVA group,40 cases) and right ventricular outflow tract group (RVOT group,38 cases) according to sites of right ventrieular pacing.The QRS duration,accumulative total right ventricular pacing percentage and left ventricle function indicators were compared between the two groups before operation and 3,9 months after operation.Results There was no statistically significant difference in QRS duration and left ventricle function indicators before operation between the two groups (P＞0.05).The QRS durations in the RVA group at 3,9 months after operation were longer than those in the RVOT group,there were statistically significant differences (P＜0.05).No statistically significant difference was found in accumulative total right ventricular pacing percentage at 9 months after operation between the two groups (P＞ 0.05).At 9 months after operation,the left ventricular ejection fraction in the RVOT group was higher than that in the RVA group,and the left ventricular end diastolic diameter was lower than that in the RVA group,there were statistically significant differences (P＜0.05).Conclusion The effects of RVOT pacing on left ventricle systolic function in elderly patients with SSS is superior to the RVA pacing.
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database until 2015-01, and all randomized controlled trials (RCT) upon (RVS) pacing and (RVA) pacing in Chinese population were enrolled. According to Cochrane Handbook 5.0.2 quality evaluation criteria, the publications were selected by 2 independent researchers and Meta-analysis was conducted with RevMan5.0 software. Results: A total of 16 RCT articles including 1199 patients were enrolled in this study. The research was divided into 2 groups: RVS group,n=602 and RVA group,n=597. Meta-analysis indicated that the following indexes in RVS group were better than those in RVA group: the differences between post-and pre-operation for the combination value in LVEF (MD=1.90, 95% CI 0.75-3.05,P=0.001), stroke volume (MD=7.08, 95% CI 2.39-11.76,P=0.003), QRS wave width (MD=29.13, 95% CI 5.71-52.54,P=0.01), LVESV (MD=2.04, 95% CI -4.22 to 8.31,P0.05. Conclusion: RVS is a relatively feasible pacing method in Chinese population.
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Objective To evaluate the effect of permanent right ventricular apical (RVA) pacing in different cumulative percent of right ventricular pacing( CUM% VP) on the heart function and cardiac ventricle structure in subjects with normal basic heart function. Methods Patients who had implanted pacemaker when heart function was still normal were recruited in the study while they revisited for replacement or examinations of implanted pacemaker at outpatient. According to different CUM% VP, patients were divided into group A ( CUM% VP≥85% ,n =78) and group B( CUM% VP≤40% ,n =63) . The primary composite endpoint was defined as new-onset heart failure, death, left ventricular ( LV ) dysfunction and remodeling. The occurrence of endpoints were compared between the two groups. The left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and interventricular septum(IVS) were measured through baseline and follow-up, their absolute alterations ( △ LVEF, △ LVEDD and △ IVS ) were observed. Results The mean duration of two assessment was 7.4 years in group A and 7.7 years in group B, respectively. Before pacemaker implantation,there were no differences in age, sex, basic diseases, cardiac function and constituent ratio of pacemakers between the two groups. By comparing the outcomes of group A with those of group B at the end of follow up, we found that: △ LVEDD in group A was significantly larger than that in group B ( [3. 8 ± 0. 5] mm vs [1.4 ± 0. 4] mm,t = 4. 540,P ＜ 0. 01 ), △ LVEF was ( - 6.5 ± 1.2) % and ( - 3.3 ± 1.0) % in group A and B, respectively,with significant difference between the two groups(t = 2. 578 ,P ＜0. 01 ). There were no significant difference in AIVS between the two groups. No death occurred in both group at the end of follow up. The incidence of LV dysfunction and remodeling was 25.6% (20/78) in group A,which was significantly higher than that of 6.3% (4/63) in group B( x2 =9. 183 ,P =0. 002). and the incidence of new-onset heart failure was 10. 3% (8/78)in group A,which was significantly higher than that of 1.6% (1/63) in group B (x2 =4.383,P =0.036).Conclusion Among patients with normal basic LV function who underwent permanent RVA pacing,there are potential risk in developing LV remodel, function damage and heart failure. The risk increases with the pacing time getting longer and CUM% VP getting higher.
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Objective To evaluate the influence of right ventricular outflow tract septal ( RVS) pacing with right ventricular apical ( RVA) pacing on left ventricular remodeling and brain natriuretic peptide ( BNP). Methods Sixty patients with indication of pacemaker implantation were randomized into two groups, RVA group and RVS group. BNP was measured with ELISA, and echocardiography was performed to measure the left ventricular end diastolic volume ( LVEDD), left ventricular end systolic volume ( LVEDV) and left ventricular ejection fraction (LVEF) at pre-operation,and after 6,12,24 months pacing. The difference of cardiac remodeling and BNP in the two groups was observed. Results Compared to BNP at pre-operation (( 60. 2 ± 15. 7 ) ng/L) , BNP increased significantly in the RVA group at the 6th,12th and 24th month after operation( ( 108. 2 ±29. 8) , ( 190. 3 ±46. 7) ,(308. 2 ±56. 5)ng/L,respectively) (P <0. 05). In the RVS group,BNP increased only at 24 months after pacing ( (75. 2 ± 15. 8) ng/L vs. (63. 9 ± 15. 1 ) ng/L) (P < 0. 05). There was significant difference on BNP between the two groups. LVEDD,LVEDV increased,LVEF declined at 12 months after pacing in the RVA group,which were not observed in the RVS group. There was significant difference on LVEDD,LVEDV and LVEF in the RVA group (P< 0. 05) between the 12th month and pre-operation,and there were no significant difference in the RVS group (P > 0. 05). Conclusions Compared to RVA pacing,RVS pacing was more beneficial to improve heart function,prevent cardiac remodeling and decline the activation of nerve-endocrine.