| Objective: The study compared the changes of left ventricular end-diastolic diameter(LVEDD), left ventricular systolic diameter(LVEDS), left ventricular ejection fraction(LVEF),right ventricular diameter(RVD)and the duration of QRS and Tp – Te between within 3 days after operation and 12 months after operation of the patients who suffer from Ⅲ degree atrioventricular block, during operation the pacemaker’s ventricular electrode was respectively fixed in right ventricular septum(RVS) and right ventricular apical(RVA), the study is aimed at find out which position is the optimization site to implant the electrode of the pacemaker, to avoid the deterioration of pacemaker implanted patients’ cardiac function.Methods: this study collected 58 patients who have got Ⅲ degree atrioventricular block and implanted double chamber pacemaker in the Department of Cardiology, the Second Hospital of Lanzhou University during September 2013 to December 2014,including 31 males and 27 females, the 58 patients were randomly divided into two groups of right ventricular apical pacing group(RVA group)and right ventricular septum pacing group(RVS group), by using the random number table. 30 people in RVA group, 28 people in RVS group. within 3 days after operation all of the patients need to complete Echocardiography and electrocardiogram examination, measured the left ventricular end-diastolic diameter(LVEDD), left ventricular systolic diameter(LVEDS), right ventricular diameter(RVD),left ventricular ejection fraction(LVEF) and the duration of QRS and Tp-Te, then implanted pacemaker in our operating room,12 month later the patients need to complete Echocardiography and electrocardiogram examination again, measured the LVEDD, LVEDS, LVEF,RVD,the duration of pacing QRS and Tp-Te interphase,finally analysis the changes of cardiac function, the size of heart chamber and electrocardiogram of two groups of patients.Results:(1)the within postoperative 3 days mean LVEDD in RVA group is 51.85±11.13 mm, postoperative 12 month mean LVEDD is 50.57±6.43 mm,there are no significant difference between them(P>0.05);in RVA group the within postoperative 3 days mean LVEDS is 33.76±6.64 mm,compared with the postoperative 12 month mean LVEDS 32.63±6.44 mm,also no statistical difference(P > 0.05); the within postoperative 3 days mean RVD in RVA group is 23.64±3.19 mm, postoperative 12 month mean RVD is 23.74±3.90 mm,there are no significant difference between them(P>0.05);in RVA group the within postoperative 3 days mean LVEF is 66.30±8.92%,compared with the postoperative 12 month mean LVEF 65.20±6.75%,also has no significant difference(P>0.05).(2) the within postoperative 3 days mean LVEDD in RVS group is 52.19±9.37 mm, the postoperative 12 month mean LVEDD is 52.31±10.79 mm,has no statistical difference(P>0.05);in RVS group the within postoperative 3 days mean LVEDS is 32.20±5.25 mm, compared with the postoperative 12 month mean LVEDS 32.41±5.20 mm, has no significant difference(P>0.05),RVD in RVS group also has no difference between the two times(P>0.05); in RVS group the within postoperative 3 days LVEF is 68.30±5.62%, compared with the postoperative 12 month mean LVEF 67.10±5.04%, no statistical difference(P>0.05).(3)compared the LVEDD, LVEDS,RVD,LVEF between RVA group and RVS group,all of them has no significantly difference(P>0.05).(4) RVA group have 30 patients,the within postoperative 3 days mean QRS width is 165.20±17.08 ms,and the postoperative 12 month mean QRS width is 169.40±21.31 ms, has no statistical difference(P > 0.05);within postoperative 3 days mean Tp-Te interval is 123.00±12.05 ms, postoperative 12 month mean Tp-Te interval is 125.00±13.14 ms,has no statistically difference(P>0.05).(5)RVS group have 28 patients,within postoperative 3 days mean QRS width is 127.90±15.52 ms, postoperative 12 month mean QRS width is 130.40±11.50 ms,no significant change(P > 0.05);within postoperative 3 days mean Tp-Te interval is 125.20±17.05 ms,postoperative 12 month the mean Tp-Te interval become 126.40±10.74 ms, has no statistical difference(P>0.05).(6)compared the within postoperative 3 days mean QRS width between RVA group and RVS group, the mean QRS width in RVS group significantly reduced(P<0.05), the mean postoperative 12 month Tp-Te interval in RVA group compare with RVS group has no significant difference(P>0.05).Conclusion: Two types of pacemaker implantation did not cause the loss of left ventricular systolic function in 12 months, and the ventricular structure did not changed too, in RVA group the QRS duration did not become wider after 12 months pacing compared with the baseline, two types of pacemaker implantation did not caused the Tp- Te become longer, so did not increase the risk of patients suffering from malignant arrhythmia. |
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