The Effects On Cardiac Function And Emotional State For Patients Pacing In Different Parts

Objective:Since the pacemaker technology applied to the clinical, it saved a large number of patients who are suffering from high degree atrioventricular block and become an effective treatment for tardy arrhythmia. The implantation of right ventricular apex electrode have been widely used in the clinical for many years because of the high density of the right ventricular apex and the easiness of the electrode implantation operation. As time goes by, a number of patients have implanted with pacemakers, and many studies found that right ventricular apex pacing can cause electrical exciting conduction differences between the right and left ventricles which can cause losses of mechanical motion and hemodynamic disorder for damage of heart perfusion. What’s more, it affect the patient’s quality of life and increase the hospitalization rate and raise the mortality of heart failure and arrhythmia. With the emergence of active electrode, pacemaker technology in the right ventricular septal area arises at the historic moment. Pacing in the right ventricular septal, in which the earliest ventricular excited point close to the Kent-His bundle and the pacemaker pulse impulse from ventricular septal and spread to the double ventricular and the apex of the heart which improve the electrical and mechanical activities between ventricular septal area and improve the quality of the patients’ life.As the updating of the times and the continuous development of new medical model. The psychological state of the patients with chronic diseases is taken seriously. Several studies have found that there are different degrees of psychological problems in cardiac pacemaker implantation, mainly include somatization disorder, anxiety, depression or bipolar disorder and affect the quality of the patient’s life which require a doctor’s psychological intervention treatment in a certain degree. Therefore, reasonable assessment and positive interventions of patients with pacemaker implantation has become the first problem to be solved.Nowdays, there are some differences between the right ventricular septal pacing and the right ventricular apex pacing and there are few studies about the psychological status in different pacing sites. In this paper, by comparing of different parts in different right ventricle pacing sites and echocardiographic parameters, we can find out the key points which affect the heart chamber size and specific indicator of cardiac function.In this paper, we discuss the patients’ heart function and emotional impacts in the two groups of patients through the analysis of the preoperative and postoperative scores of mental health and look for the best position of the pacemaker electrode implanation.Methods:72 patients who were suffering from high or complete atrioventricular block which need selective implantation of pacemaker of VVI and DDD mode between 2013-2014 were enrolled in this experiment. According to the images during the operation and the ECG in pacing, the patients were divided into the right ventricular septal area pacing group and the ventricular apex pacing group. The low septal area pacemaker group was put into the apex pacing group and the right ventricular free wall group was excluded. We collect the pacing threshold, the perception threshold and the electrode impedance as well as injury current before the screwing in endocardium, 5min after screwing in and 10 min after screwing in. The echocardiography was performed before and one year after the operation. We also collected the parameters such as the LVEDD the LVEF the E/A and the LAD of the Echocardiography as well as the ECG parameters such as QRS duration QT interval and pacing JTc interval. Hamilton Anxiety Depression Scale and Hamilton Anxiety Rating Scale was also performed one week three months and one year respectively after the operation. We analysis the different impacts on the emotions in different time and different locations.Results:The collection of the preoperative data and the paraments of operation were completed. We also collect the injury current and finish the outpatient follow-up. The duration of the QRS in pacing ECG prolong than the pre-operation in the two groups, the duration of the QRS and the JTc in the right ventricular apex pacing group is longer than the septal area pacing group. The echocardiographic date reveals that the LVEDD and the LAD in the right apex group increase than the right ventricular septal area pacing group one year after the operation, the LVEF and the E/A in the right apex pacing group decrease than the right ventricular septal area pacing group. There is no difference between the two groups in the pacing threshold the perception and the electrode impedance. There are interactions between the two groups in different time. There is no injury current before the screwing but different injury current in the immediate time 5min and 10 min respectively after the screwing. It is 5min after the screwing that the injury current decrease to the most extent, and it is about 10 min that the injury current back to the normal level after the screwing. For different groups, there is no obvious difference of the injury current among the time before screwing in the immediate time and 5min after screwing in the endocardium. The injury current in ventricular septal is higher than the apex of the ventricular 10 min after the screwing. There is no difference obvious between anxiety and depression scores between the preoperative right ventricular septal group and the right ventricular apex group. The anxiety degree in the ventricular apex group is higher than the right ventricular septal group one week after the operation. The anxiety score in the right ventricular apex group is higher than the group of the ventricular septal group. Pacing in the right ventricular septal can improve cardiac function, reduce the cardiac remodeling which is superior to the right ventricular apex pacing group. Different locations cause different mental health, the events of operation will do adverse impact on patients psychological status. The psychological ratings of surgery after the acute phase was obviously improved compared with preoperative psychological situation of patient and surgical acute stage, The mental health status of the patients is not only related to the implantation time,, but also related to the implanted position.Conclusion:Pacing in the right ventricular septal is superior to the right ventricular apex pacing group which can improve the cardiac function and reduce the cardiac remodeling. Different locations cause different mental health,the operation events will have adverse impact on patients psychological status. The psychological ratings of surgery after the acute phase, compared with preoperative psychological situation of patient and surgical acute stage was obviously improved and the mental health status of the patients are not only related to the implantation time, but also related to the implanted position.