CRT治疗慢性心衰的临床观察

Clinical observation on the effect of cardiac resynchronization therapy for the patients with chronic heart failure

目的观察心脏再同步化治疗(CRT)慢性心力衰竭(CHF)患者的临床疗效。方法选择2006年5月～2009年4月植入CRT起搏器的患者8例,其中7例为窦性心律;1例为房颤。优化AV间期及/或VV间期等参数,随访10.1±8.9个月,观察患者心功能改善情况、QRS波时限改变和左室射血分数(LVEF)、左室舒张末内径(LVEDD)、二尖瓣返流及左/右心室不同步等心脏超声参数的变化。结果所有8例患者植入CRT起搏器后,心功能分级与LVEF提高,临床症状明显减轻,6分钟步行距离增加,QRS波时限、LVEDD及MR减少,左/右心室不同步明显改善,心衰平均住院时间减少约33%(p<0.05);1例患者CRT植入后13个月发生VT/VF猝死。结论CRT可明显改善CHF患者的心功能,缓解临床症状并提高生活质量;对可能发生VT/VF的高危CHF患者,置入CRT(D)可预防心源性猝死。

Objective To observe and evaluate the effect of cardiac resynchronization therapy（CRT） for the patients with chronic heart failure （CHF）. Methods From May 2006 to April 2009, eight patients with CHF were treated by CRT （D） implantation. The CRT （D） was done by DDD pacing in the right atrium and the left and right ventricles for 7 of the patients with sinus rhythm, and by VVI pacing in the left and right ventricles for the patient with AF. The AV delay and VV interval were optimized and the following up had been done for 10.1±8.9 months. Results Since the CRT（D） implantation, the condition of all of the 8 patients had been improved significantly for increasing in NYHA, LVEF（%）,6min walking and decreasing in LVEDD（mm）, MR and QRS duration （p〈0.05）. The average time of hospitalization was decreased for 33%. One patient died of VT/VF 13 months after the implantation. Conclusion The condition of the patients with CHF can be improved by CRT significantly. CRT-D should be implanted for the CHF patients with high risk of VT/VF to prevent sudden cardiac death.