慢性心力衰竭合并持续性心房颤动患者心脏再同步治疗术后房室结消融及药物控制心室率疗效观察

A comparison different rate-control in patients with heart failure and atrial fibrillation underwent resynchronization therapy

目的观察慢性心力衰竭合并持续性心房颤动（房颤）患者心脏再同步治疗（CRT）的疗效，比较房室结消融术及药物控制心室率两种方法疗效的差异。方法慢性心力衰竭合并持续性房颤患者，符合CRT植入适应证并接受CRT或心脏再同步治疗除颤器（CRT—D）植入术，术后随机分为两组，房室结消融组以及药物治疗组，术后随访观察患者临床症状及心功能改善等情况，比较两组的疗效。结果共人选了26例患者，其中房室结消融组14例，药物控制组12例。术前两组患者间心功能，左心室舒张末期内径（LVEDD），左心室射血分数（LVEF）及用药等基本情况差异无统计学意义。CRT术后随访结果，房室结消融组双心室起搏比例100％，药物治疗组双心室起搏比例72．0％±9．7％。与药物治疗组相比，房室结消融组LVEDD略有缩小[（61．0±6．9）mm对（62．0±7．8）mm]，但差异无统计学意义（P=0．08），LVEF改善明显（0．41±0．06对0．35±0．04），差异有统计学意义（P=0．04），提示房室结消融组疗效更佳。结论对慢性心力衰竭合并持续性房颤患者，CRT可以改善患者心功能，CRT术后行房室结消融可以提高有效的双心室起搏比例，进一步提高CRT疗效。

Objective To evaluate the effects of different rate control methods in cardiac resynchronization therapy （CRT） patients with chronic congestive heart failure（CHF） and permanent atrial fibrillation（AF）. Methods Patients with CHF and permanent AF were eligible for enrolment after resynchronization. Patients were raudomed to medical therapy group and atrio-ventricular junction ablation group after CRT or CRT-D implantation. Improvement of symptom and Left ventricular ejection fraction （LVEF）were documented duration follow-up to compare the clinic effects between two groups. Results Twenty-six patients with CHF and perma- nent AF were eligible for enrolment after resynchronization and were randomized to medical therapy group and atrio-ventricular junction ablation group after CRT or CRT-D implantation（ 12 in medical therapy group and 14 in atrio-ventricular junction ablation group）. The baseine clinical characteristics were similar in two groups. Reverse remodeling was achieved with cardiac function improved in all patients after resynchronization. Com pare with medical therapy group, patients in atrio-ventricular junction ablation group showed more significant reduction of left ventricular end-diastolic dimension [ LVEDD, （ 61, 0 ± 6. 9 ）mm vs （ 62.0 ± 7.8 ） mm, P = 0.08 and increase of left ventricular ejection fraction （ LVEF ,0. 41 ＋0.06 vs 0. 35±0. 04 ）, P = 0. 04）. Conclusions CRT improve the LV systolic function in patients with chronic congestive heart failure and permanent atrial fibrillation. Atrio-ventricular junction ablation after resynchronization improved the percentage of effective biventricnlar pacing and the efficacy of CRT.