| Background and Objective:The advent of artificial cardiac pacemaker brought far-reaching influence in the treatment of bradyarrhythmias. With the continuous development of science and technology of the pacemaker and the mature of pacemaker implantation technology, pacemaker’s role in the treatment of bradyarrhythmias is gradually improving, it has been the most safe and effective method. The purposes of pacemaker treatment are not only to maintain the patient’s base rate, it is more important to improve the quality of life. However, with the increasing number of implanted pacemakers and the standardized of postoperative, many problems are standing out. Although patients with implanted pacemaker can avoid syncope which due to bradycardia and fatigue caused by insufficient cardiac output, postoperative atrial fibrillation (AF), heart failure incidence is higher. Currently a number of studies have found that pacemaker trigger activation abnormalities the excited conduction of the heart itself, which leading to abnormal mechanical contraction. So in order to make it working more physically, we should keep a physical AV interval, and make two ventricles work coordinately, also the contraction of intraleftventricular. So it is crucial of the selection of the pacing site,and the proper settings of pacing mode. The pacing parameter setting is also played a crucial role. With the great progress in the treatment of heart failure with resynchronization therapy. The studies of the optimized parameters in resynchronization therapy become more widely, but studies about dual chamber pacemaker are few. At present, optimization parameters of dual pacemaker mainly have been done in the clinic, whether it can achieve effective physiological pacing is not clear because of the lack of guidance hemodynamic parameters.In addition to the ventricular electrode position may affect heart function, the parameters of atrioventricular interval can also influence the hemodynamics. Whether the long-term of hemodynamic abnormalities can contribute to atrial fibrillation or cardiac dysfunction is not clear. This study is aimed to compare the hemodynamic between the optimization of atrioventricular interval under the guidance of echocardiography and optimization with experience trying to explore the effective ways to maximize the benefit of the pacemaker.Methods:The study enrolled 66 patients who were implanted with DDD pacemaker in our hospital from May 2014 to December 2014. They were randomly divided into two groups.One week after the operation, atrioventricular interval was programmed with experience in group A. At the same time, we used echocardiography to optimize the atrioventricular interval in group B. The first follow-up began at 3 months after implantation, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), aortic valve velocity time integral (VTI), brain natriuretic peptide (Pro-BNP),6-minute walk distance test (6MWT), New York Heart Association functional class (NYHA) were evaluated and then programmable methods of the atrioventricular interval were exchanged. Another 3 months later, the second follow-up came.The cardiac function was tested again.Then we evaluated the differences between the two methods for the benefits of cardiac function through comparison before-after.Results:No difference was found in the proportion of ventricular pacing. In group A, the cardiac function index at 6 months was better than that at 3 months[LVEF (56.2 ±3.3)% vs (60.7 ± 4.3)%, P=0.038; VTI (22.6 ± 4.5)cm vs (25.1 ± 4.6)cm, P=0.027; 6MWT (327.4 ±128.6)m vs (396.5 ± 115.1)m,P=0.015; Pro-BNP (298.6 ± 198.6)pg/ml vs (118.3 ± 156.4)pg/ml,P=0.028]. The difference was statistically significant. In group B, the cardiac function index at 3 months was preferable to that at 6 months[LVEF (59.2 ± 5.6) vs (58.2 ± 4.2), P=0.024; VTI (25.2±4.9)cm vs (23.1 ± 3.9)cm, P=0.014; 6MWT (379.8 ± 108.7)m vs (364.8 ± 113.7)m,P=0.039; Pro-BNP (187.5 ± 157.6)pg/ml vs (243.4 ± 186.9)pg/ml,P=0.014]. The difference was also statistically significant. NYHA and LVEDd were not changed obviously.Conclusion:Atrioventricular optimization with echocardiography helps maintain heart function. Furthermore, Echocardiography can be an effective instructive method to optimize the atrioventricular interval of dual pacemaker. |
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