Objective Respectively applying the treatment of biventricular pacing and right ventricular septal pacing in atrioventricular block,to compare the heart function influence of two kinds of pacing mode on pacemaker dependent patients, to provide evidence for the physiological pacing mode selection?Methods Enrolled 20 patients from January 2012 to March 2013 who should be placed in pacemakers, their primary disease was the second degree,high or third degree atrioventricular block,giving them three chamber pacemaker ( right atrial + biventricular ) each?Randomly divided into right ventricular septum pacing group ( group A, n=10) and biventricular pacing group( group B,n=10)?Twelve months later,each group crossed into the each other group and continued following?up for 12 months?After 24 months to obtain all the data to do the statistical analysis,including patients'6 min walking distance(6MWD),the Minnesota Heart Failure Quality of life score (MLHFQ),plasma N?terminal pro brain natriuretic peptide precursor(NT?proBNP),left ventricular ejection ejection fraction(LVEF),left ventricular diastolic end diastolic diameter(LVEDD),left ventricular contraction end diastolic diameter(LVESD),left ventricular twelve segmental 14W time standard deviation(Ts?12SD),left ventricular twelve segmental 14W time maximum delay(Ts?dif),the paced QRS qrsd?Results Compared with group B,the 6MWD and LVEF of 12,24 months after treatment of group A were significantly increased( ( 242?58 ±37?56) m vs?(347?42±36?59) m vs?(340?67±24?99) m;(39?97±5?84)% vs?(57?92±10?01)% vs?(60?50±10?06)%;P<0?05),QRSd and NT?proBN were significantly decreased((139?25±10?43) ms vs?(114?25±10?07) ms vs?(110?83±11?08) ms) ms;( 2 857?84±236?48) ng/L vs?( 2 144?26±301?43) ng/L vs? (2 025?91±307?42) ng/L;P<0?05)?Compared with before treatment,at 12 and 24 months after treatment,6MWD in group B was significantly increased(228?17+38?06) m,(329?33+46?28) m,(350?67+35?43) m, LVEF was significantly increased ( ( 40?25+11?24 )% vs? ( 59?50+9?14 )% vs? ( 60?17+10?29)%),QRSd significantly narrowed((142?42+10?66) ms vs?(118?58+994) ms vs?(116?25+10?59) ms) and NT proBNP levels significantly reduced((2 848?25+318?65) ng/L vs?(2 144?26+301?43) ng/L vs?( 2 025?91+30?742) ng/L) were,the difference had statistical significance ( P<0?05)?There was no significant difference on the different time between the groups ( P=0?05)?Comparisons between A and B group at the same treatment time,these indexes of detections were no statistical significance(P>0?05)?Conclusion Compared with the right septal pacing,biventricular pacing is of no significant advantages on the effect of cardiac function for patients with pacemaker dependent.

Objective To investigate the impacts of treating stratege for non-infarct related artery on clinical prognosis in elderly patients with acute myocardial infarction (AMI) after urgent percutaneous coronary intervention (PCI). Methods From Augst 2007 to Augst 2010,a total of 75 elderly AMI patients (aged 75 years and over) were treated by urgent PCI and confirmed as multivessel coronary disease in our hospital. Among them,30 patients received medicine combined with PCI once again (PCI group) and 45 patients received only medicine treatemt (medicine group).The major adverse cardiovascular events (MACE) and results ot coronary angiography after treatment for average one year were compared between the two groups. Results There were no significant differences in the rates of in stent restenosis[1 case(2.2 ％)vs.0 case],late loss of in-segment lumen [5 cases(11.1％)vs.3 cases(10.0％)],stent thrombosis[1 case(2.2％)vs.1 case(3.3％)] and larget vessel revascularization [2 cases (4.4 ％ ) vs.1 case ( 3.3 ％) ] between medicine group and PCI group (x2=0.00,0.00.2.03 and 0.00,all P＞0.05).The propertions of angina recurrence and second hospital admission for heart diseases were lower in PCI group than in medicine group [36 cases (80.0％)vs.14 cases(46.7％),18 cases(40.0％)vs.5 cases(16.7％),x2=9.00,4.61,P＜0.01and P＜0.05].However,no differences were found in the secondary heart failure,recurrent nonfatal myocardial infarction,severe arrhythmia,all- cause death and mortality rate of cardiovascular disease between the two groups (x2 =0.09,0.00,0.00,0.00 and 0.00,all P＞ 0.05). Conclusions Compared with single medicine therapy,the medicine combined with PCI for non- infarct-related artery may decrease the rates of angina recurrence and second hospital admission for heart diseases in elderly patients with AMI.