双心室起搏的初步临床经验

Clinical application of biventricular pacing

目的 探讨缺血性或扩张型心肌病合并充血性心力衰竭行永久性双心室起搏治疗的临床效果。 方法 对 5例缺血性或扩张型心肌病合并难治性心力衰竭和左束支阻滞患者常规植入右心室起搏导线的同时植入冠状静脉窦导线于心大静脉或心中静脉 ,分别行右心室心尖部起搏及双心室起搏 ,应用 Swan- Ganz导管或超声心动图测定不同起搏部位对心功能的影响。 结果 在充血性心力衰竭合并左束支阻滞患者植入冠状静脉窦导线至心大静脉或心中静脉行双心室起搏 ,与右心室心尖部起搏比较有更好的急、慢性血流动力学效应 ,双心室起搏引起窄 QRS波 ,同时使二尖瓣返流减少 ,射血分数提高 ,心功能改善。 结论 双心室起搏对难治性心力衰竭可能有辅助治疗作用。

Objective To evaluate the clinical efficacy of biventricular pacing on treating patients of chronic congestive heart failure due to ischaemic or dilated cardiomyopathies. Methods Five patients suffered from ischaemic or dilated cardiomyopathies with refractory heart failure were implanted with a coronary sinus(CS) lead into the great (4 cases) or middle (1 cases) cardiac vein,and a right ventricular apex lead.These leads were composed of the right ventricular apical pacing and biventricular pacing.The hemodynamic parameters with different pacing modes were evaluate by the echocardiography and Swan Ganz catheterization. Results The biventricular pacing increased strok volume and cardiac output.The biventricular pacing showed a narrow QRS wave. Conclusion The biventricular pacing might improve the heamodynamics of refractory congestive heart failure patierts.