长期右心室起搏出现心力衰竭的患者升级三腔起搏对心功能的影响探讨

Preliminary Investigation for Dual-Chamber Pacemaker Upgraded to Three-Chamber Pacing in Treating the Patients With Long Term Right Ventricular Pacing Appearing Heart Failure

目的:针对长期右心室心尖起搏后出现心力衰竭的患者,观察采用双腔起搏器升级三腔起搏治疗心力衰竭的临床疗效。方法:10例植入永久双腔起搏器后出现心力衰竭的患者,术中保留原心房和右心室心尖部永久起搏导管,并经左锁骨下静脉植入左心室永久起搏导管至左心室侧静脉或侧后静脉起搏左心室。观察三腔起搏术后0.5、1、2、3年10例患者纽约心脏协会(NYHA)心功能分级、六分钟步行试验、左心室舒张末径、左心室射血分数的变化。结果:三腔起搏术后0.5、1、2、3年的随访,10例患者无死亡发生,因心力衰竭住院次数明显减少、NYHA心功能分级长期维持在II^III级、六分钟步行试验显著延长、左心室舒张末径减小、左心室射血分数增加。结论:长期右心室心尖起搏后出现心力衰竭的患者,双腔起搏器升级三腔起搏可改善患者的左心功能。

Objective： To explore the effect of dual-chamber pacemaker upgraded to three-chamber pacing in treating the patients with long term right ventricular pacing appearing heart failure （HF）. Methods： We studied 10 patients who received dual-chamber pacemaker implantation appearing HF, those patients were treated with upgraded biventricular three-chamber pacing by reserving the original atrium and right ventricular apical pacemaker catheter, then implanting left ventricular pacing catheter via left sub-clavian vein or left posterior vein to pacing left ventricle. We observed the post procedural HF caused hospitalization per year, NYHA classification, 6-minute walking test, left ventricular end-diastolic diameter （LVEDD） and left ventricular ejection fraction （LVEF） for 0.5, 1, 2 and 3 years in all 10 patients. Results： During 3 years follow-up period, the patients presented obviously less HF caused hospitalization, NYHA classification maintained at Ⅱ～Ⅲ for long term, significantly increased 6-minute walking distance, decreased LVEDD and increased LVEF. Conclusion： In patients with long term right ventricular apical pacing appearing HF, upgrading from dual-chamber pacemaker to biventricular three-chamber pacing could improve the patients＇ left cardiac function.