心脏再同步治疗房室间期的优化

Cardiac resynchronization therapy with optimized dynamic AV delay for patients with congestive heart failure

目的评价房室(AV)间期动态优化的心脏再同步治疗对慢性心力衰竭的疗效。方法63例因心力衰竭接受心脏再同步治疗的患者分别于植入起搏器术后1周、6个月及12个月在超声指导下行AV间期优化。定义最佳AV间期为超声心动图指标E、A峰最大分离并无切尾。同时分别行超声心动图及心电图、6分钟步行距离试验(6MHW)、明尼苏达HF患者生活质量问卷评分(QOL)。结果本组最佳优化AV间期在90～140(110.45±19.47)ms。CRT植入后1周同植入前比较,左室射血分数(LVEF,22.07%±6.77%比18.53%±4.83%)和左心室舒张期充盈时间(LVFT,293.27±24.79ms比272.35±56.00ms)明显提高,QRS波宽度变窄(129.40±6.65ms比138.25±28.00ms),P均<0.05,差异有统计学意义。跟优化前比,AV间期动态优化后的6个月和12个月LVEF值由22.07%±6.77%增加至32.24%±10.34%及36.86%±9.29%;6min步行距离(6MHW)由术前268.70±22.25m增加至327.12±15.24m及347.62±15.04m;QRS时限无明显变化;左心室舒张末期直径(LVEDD)由71.43±7.12mm降至65.88±9.85mm和57.06±6.54mm;生活质量问卷评分(QOL)由72.14±6.24降低至61.68±12.28和55.15±11.02;NHYA心功能分级由3.12±0.55减至1.68±0.67和1.82±0.43。结论动态优化AV间期可以提高心脏再同步治疗对慢性心力衰竭的短期、中期、远期疗效。

Objective To evaluate the effects of cardiac resynchronization therapy with optimized dynamic AV delay. Methods The study included 63 patients who underwent implantation of biventrieular pacemakers for congestive heart failure. The dynamic AV delay was optimized on the day 1 week, 6 months and 12 months after pacemaker implantation. The echocardiography and ECG, 6MHW, QOL and NYHA grade were evaluated at the same time. Results The best optimized AV delay was between 90 ms and 140 ms （110. 45± 19.47 ms）. Comparing the effectiveness 1 week after CRT with the day before CRT： the LVEF increased from 18.53% ±4.83% to 22. 07% ±6. 77% with the QRS interval decreased from 138.25 ± 28.00 ms to 129. 40 ± 6. 65 ms. Comparing the effectiveness of the day before and in 6 - 12 months after CRT optimized AV delay, the LVFT increased from 293.27 ±24. 79 ms to 347.57 ±26. 21 ms. There was no difference in QRS intervals. The LVEDD was upgraded from 71.43 ±7. 12 mm to 57.06±6. 54 mm while the QOL was upgraded from 74.14±6. 24 to 55.15 ± 11.02 and the NHYA upgraded from 3.12 ±0. 55 to 1.82 ± 0. 43. Conclusion Optimized dynamic AV delay of the pacemaker parameters enhanced the shortterm and long-term efficacy of CRT.