选择部位起搏新进展概念.pptx

选择部位起搏新进展为何起搏? 何处起搏? 起搏的首要目的，是解决心动过缓。心房导线则是为恢复房室同步顺序。起搏导线设计是为了将电信号，方便可靠地传送到右心室和右心房。右室心尖部和右房心耳部由于方便、稳定被许多人应用。为什么要改变？现在是时候放弃右室心尖部起搏，转向间隔部起搏了！7 —— Harry Mond1. Manolis AS. The deleterious consequences of right ventricular apical pacing: time to seek alternate site pacing. Pacing Clin Electrophysiol 2006;29:298–315.2. Nahlawi M, Waligora M, Spies SM, Bonow RO, Kadish AH, Goldberger JJ. Left ventricular function during and after right ventricular pacing. J Am Coll Cardiol 2004;44:1883–8.3. O’Keefe JH Jr, Abuissa H, Jones PG, Thompson RC, Bateman TM, McGhie et al. Effect of chronic right ventricular apical pacing on left ventricular function. Am J Cardiol 2005;95:771–3.4. Barold SS, Ovsyshcher EI. Pacemaker-induced mitral regurgitation. Pacing Clin Electrophysiol 2005;28:357–60.5. Gardiwal A, Yu H, Oswald H, Luesebrink U, Ludwig A, Pichlmaier AM et al. Right ventricular pacing is an independent predictor for ventricular tachycardia/ventricular fibrillation occurrence and heart failure events in patients with an implantable cardioverter–defibrillator. Europace 2008;10:358–63.6. Wilkoff BL, Cook JR, Epstein AE, Greene HL, Halltrom AP, Hsia H et al. Dualchamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the dual chamber and VVI implantable defibrillator (DAVID) trial. JAMA 2002;288:3115–23.7. Liberman。 Ventricular Pacing Lead Location Alters Systemic Hemodynamics and Left Ventricular Function in Patients With and Without Reduced Ejection Fraction。 JACC Vol. 48, No. 8, 20068. Harry Monday。 The road to right ventricular septal pacing: techniques and tools.Pacing Clin Electrophysio 2010 Jul;33(7):888-98. Epub 2010 Apr 26.右室心尖部起搏，已被广泛认为并非理想永久起搏位点1；右室心尖部起搏，会引起：右室功能减低2、3，二尖瓣功能减低4，致心律失常作用5和增加死亡率6；右室心尖部起搏，会降低左室功能，无论原来左室功能是否良好。右室选择部位起搏可以避免左室功能减退。7为什么要改变？9. Occhetta E et al. Future easy and phusiological cardiac pacing. Wor;d Journal of Cardiology 2011;26; 3(1):32–39.传统右心耳起搏会造成房间和房内传导延迟，从而增加房颤发生风险9；房间隔起搏可以：1. 缩短房间传导延迟，缩短P波时长；2. 减少心房不应期离散；3. 更同步