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Effect of right ventricular pacing lead site on left ventricular function in patients with high-grade atrioventricular block: results of the Protect-Pace study.
右心室起搏点对高级别房室传导阻滞患者左心室功能的影响: Protect-Pace 研究结果。
Left ventricular function Right ventricular apical pacing Right ventricular high septal pacing Select site pacing
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摘要

AIM:Chronic right ventricle (RV) apical (RVA) pacing is standard treatment for an atrioventricular (AV) block but may be deleterious to left ventricle (LV) systolic function. Previous clinical studies of non-apical pacing have produced conflicting results. The aim of this randomized, prospective, international, multicentre trial was to compare change in LV ejection fraction (LVEF) between right ventricular apical and high septal (RVHS) pacing over a 2-year study period.
METHODS AND RESULTS:We randomized 240 patients (age 74 ± 11 years, 67% male) with a high-grade AV block requiring >90% ventricular pacing and preserved baseline LVEF >50%, to receive pacing at the RVA (n = 120) or RVHS (n = 120). At 2 years, LVEF decreased in both the RVA (57 ± 9 to 55 ± 9%, P = 0.047) and the RVHS groups (56 ± 10 to 54 ± 10%, P = 0.0003). However, there was no significant difference in intra-patient change in LVEF between confirmed RVA (n = 85) and RVHS (n = 83) lead position (P = 0.43). There were no significant differences in heart failure hospitalization, mortality, the burden of atrial fibrillation, or plasma brain natriutetic peptide levels between the two groups. A significantly greater time was required to place the lead in the RVHS position (70 ± 25 vs. 56 ± 24 min, P < 0.0001) with longer fluoroscopy times (11 ± 7 vs. 5 ± 4 min, P < 0.0001).
CONCLUSION:In patients with a high-grade AV block and preserved LV function requiring a high percentage of ventricular pacing, RVHS pacing does not provide a protective effect on left ventricular function over RVA pacing in the first 2 years.
PROTECT-PACE:ClinicalTrials.gov number NCT00461734.

译文

目的: 慢性右心室 (RV) 心尖部 (RVA) 起搏是房室 (AV) 阻滞的标准治疗方法,但可能对左心室 (LV) 收缩功能有害。以前对非心尖部起搏器的临床研究产生了相互矛盾的结果。这项随机、前瞻性、国际性、多中心试验的目的是比较右室心尖部和高间隔 (RVHS) 之间左室射血分数 (LVEF) 的变化在 2 年的研究周期内踱步。
方法和结果: 我们随机选择了 240 名患者 (年龄 74 ± 11 岁,67% 为男性),他们的高级别房室传导阻滞要求> 90% 的心室起搏,并保留了基线 LVEF> 50%, 在 RVA (n = 120) 或 RVHS (n = 120) 处接受起搏。两年后,RVA (57 ± 9 到 55 ± 9%,P = 0.047) 和 RVHS 组 (56 ± 10 到 54 ± 10%, P = 0.0003)。然而,在确诊的 RVA (n = 85) 和 RVHS (n = 83) 导联 (P = 0.43) 之间,患者内 LVEF 的变化没有显著差异。两组在心力衰竭住院、死亡率、心房颤动负担或血浆脑钠肽水平方面没有显著差异。将导线放置在 RVHS 位置需要更多的时间 (70 ± 25 vs.56 ± 24 分钟,P <0.0001) 透视时间较长 (11 ± 7 vs.5 ± 4 分钟,P <0.0001)。
结论: 在高级别房室传导阻滞和左室功能保留的患者中,需要高比例的心室起搏, 在最初的 2 年里,RVHS 起搏器对左心室功能的保护作用不超过 RVA 起搏器。
PROTECT-PACE: ClinicalTrials.gov 号 NCT00461734.

atrioventricular block

心血管 心电图 临床研究术语
概述  :  

房室阻滞(AVB)的心电图临床常见,AVB是指心脏特殊传导系统的电活动从心房下传心室的过程中出现了传导延缓或传导中断的现象。根据传统概念,房室阻滞分为不全性和完全性AVB,前者包括一度AVB,二度AVB和高度AVB,而完全性AVB又称三度AVB。房室传导阻滞部位的判断依据1、P波形态时限:在PR间期延长的同时,若伴有P波形态时限的改变,尤其对于先天性心脏病患者,应考虑到心房水平阻滞存在的可能。2、PR间期与RP间期的关系:房室结相对不应期较长,PR间期随RP间期呈反变关系。浦肯野纤维的相对不

Atrioventricular  英 [,etrɪovɛn'trɪkjəlɚ]

释义   adj. 心房与心室的,房室的

例句   To investigate cell type and size of fetus atrioventricular node.

探讨胎儿房室结内的细胞类型和大小。

 

Block 英 [blɒk] 美 [blɑːk]

释义   n. 块;街区;大厦;障碍物

vt. 阻止;阻塞;限制;封盖

adj. 成批的,大块的;交通堵塞的

例句   Then go one block to the traffic light.

然后再走过一街区到红绿灯处。



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