对心肌病晚期心力衰竭患者行左心室和双心室起搏的血流动力学研究

Comparison of hemodynamic response between left ventricular and biventricular pacing in cardiomyopathy patients with LBBB

目的 了解左心室和双心室起搏的急性期血流动力学效应。方法 对 16例心电图呈左束支传导阻滞 (LBBB)的晚期心肌病患者行左室游离壁和双心室起搏 ,记录左室、双心室和基础状态下的左室腔内最大压力上升速率 (dP dtmax)、主动脉根部压力和心电图QRS波宽度。结果 左室和双心室起搏分别使左室dP dtmax提高 2 1%和 18% (P <0 0 1) ,左室和双心室起搏组间无显著差异 ;左室起搏和双心室起搏使主动脉收缩压较基础状态升高 6 %和 5 % (P <0 0 1) ,左室和双心室起搏组间差异不显著 ;左室起搏心电图QRS间期缩短不明显 ,而双心室起搏QRS间期明显缩短。结论 对于心电图呈LBBB型的心肌病终末期心力衰竭患者 ,行双心室起搏和左室游离壁起搏均使患者的急性期血流动力学得到显著改善 。

Objective To make hemodynamic assessment of left and biventricular pacing in cardiomyopathy patients with end stage heart failure Methods Sixteen cardiomyopathy patients with LBBB were studied Left ventricular dP/dtmax, aortic root pressure and QRS duration were measured under the condition of left free wall pacing, biventricular pacing and baseline Results Compared with the baseline,left ventricualr pacing improved dP/dtmax by 21% and systolic pressure by 6% ( P <0 01); biventricular pacing raised LV dP/dtmax by 18% and systolic pressure by 5% ( P <0 01) No significant difference was observed between left and biventricular pacing groups Mechanical improvement with biventricular pacing was associated with QRS narrowing, but in left ventricular pacing group, QRS duration showed no changes Conclusion The two pacing modes (left and biventricular) were associated with almost equivalent hemodynamic improvement in terms of LV dP/dtmax and aortic root systolic pressure