双心室同步起搏治疗顽固性心力衰竭的临床研究

CLINICAL STUDY OF OBSTINATE HEART FAILURE TREATED BY SYNCHRONOUS BIVENTRICULAR PACING

目的:观察双心室同步起搏对扩张型心肌病顽固性心力衰竭的治疗效果。方法:10例扩张型心肌病病人,男6例,女4例,所有病人符合NYHA心功能III^IV级,心电图呈窦性心律,完全性左束支传导阻滞,QRS时限>120 m s,射血分数<35%,左室内径>60 mm。因严重心力衰竭而长期卧床,经多种抗心衰药物治疗效果不佳。分别植入右心房、右心室和冠状静脉左室分支电极导线,行房室顺序双心室同步起搏,观察起搏前、后QRS时限、NYHA心功能分级、左室内径、射血分数及6 m in步行试验的变化。结果:右心房、右心室和左心室电极导线感知和起搏参数均符合起搏要求。起搏后QRS时间明显缩短(P<0.01),(NYHA)心功能分级进一步改善(P<0.01),左室射血分数及6 m in步行增加(P<0.01)。结论:双心室同步起搏治疗可缓解心衰的症状,改善心功能,增加射血分数,提高运动耐量。

Objective：To assess the effect of synchronous biventricular pacing on obstinate heart failure in patients with dilated cardiomyopathy. Methods：Ten patients with heart failure of New York Heart Association（NYHA） functional class Ⅲ to Ⅳ, QRS 〉 120ms, left ventricular ejection fraction （LVEF） 〈 35%, left ventricular end diastolic diameter 〉 60mm and refractory to drug therapy were selected including six males and four females. Biventricular synchronous pacing was performed after implantation of an atrio - biventricular pacemaker. Serial LVEF, NYHA class heart function and 6 minutes hall walk were evaluated bcforc and after up to 6 months of pacing . Results： Thc acute pacing and sensing thresholds measured during the implanting procedure were normal. The QRS duration was significantly shortened by biventricular pacing in comparison with baseline（ P 〈0.01 ）. NYHA functional class reduced dramatically （ P 〈 0.01 ）, LVEF increased （ P 〈 0.01 ）, 6 minutes hall walk improved steadily（ P 〈 0.01 ）. Conclusion： Synchronous biventricular pacing is likely associated to the improvements of hemodynamics, heart function, exercise tolerance and symptoms.