双心室优化程序起搏治疗充血性心力衰竭及短期随访结果

Biventricular pacing therapy in 6 patients with congestive heart failure:initial clinical experience and results of short-term follow-up

目的报道6例使用双心室优化起搏治疗充血性心力衰竭患者,探讨双心室优化起搏治疗的初步临床经验及V-V起搏间期优化方法。方法自2004年3月起对6例顽固性充血性心力衰竭且药物治疗效果不佳的患者植入了InSyncⅢ(8042型)起搏器。全部患者术前48h之内接受常规超声心动图检查、6min室内平面步行试验(6MHW)、临床心功能评估等作为基础对照。出院前行心室起搏优化确定最佳V-V起搏间期,术后1、3、6个月再次重复上述检查并动态心电图检查,其中第6个月重新优化V-V起搏间期。结果6例患者均顺利完成起搏器植入术。5例患者起搏方式为心房感知并心室起搏,其中总心室起搏数均>90%。1例患者起搏方式为心房感知并心室起搏,其中总心室起搏数为94%。全部患者临床心功能指标(NYHA分级)和6min室内平面步行试验均较术前有显著提高。从双心室优化起搏的即刻效果来看,优化V-V间期使主动脉瓣射血时间-速度积分(VTI)从术前的(20.7±6.6)cm增加至(23.5±6.6)cm。左心室射血分数从术前的0.24±0.09增加至0.29±0.08。结论双心室起搏治疗能改善顽固性充血性心力衰竭且药物治疗效果不佳患者的心功能,提高患者的生活质量,在此基础上进行V-V间期优化可以进一步提高患者的左心室功能。

Objective The aim of this study is to report biventricular pacing in 6 patients with congestive heart failure(CHF) and discuss the initial clinical experience with biventricular pacing and V-V optimization. Methods From March 2004,6 patients with CHF refractory to standard pharmacutical therapy were treated by implanting InSync Ⅲ (8042) pacemakers.All patients received routine echocardiography examination,6 Minutes Hall Walking(6MHW) and clinical cardiac function evaluation as baseline within 48 hours before implantation.Before discharge optimal V-V delay would be determined.Repeating the above mentioned examinations on month 1, month 3, and month 6 after implantation and on month 6 re-optimizing the V-V delay was performed.Results InSync Ⅲ were all successfully implanted in all 6 patients.Five patients were atrial sensing with ventricular pacing and total percentage of ventricular pacing were over 90%.One patient was atrial pacing with ventricular pacing and ventricular pacing was around 94%.Cardiac function (NYHA class) and 6MHW were significantly improved in all 6 patients compared with those at baseline.The instant effect of optimizing V-V delay showed aortic velocity time integral could be increased to(23.5±6.6)cm from(20.7±6.6)cm of prior optimization,ejection fraction could be increased to 0.29±0.08 from 0.24±0.09 of prior optimization.Conclusion Biventricular pacing can improve cardiac function,enhance life quality in refractory CHF patients.V-V optimization can further improve ejection fraction.After initial optimization of V-V delay,patient may not need multiadjustment of V-V delay during follow-up.