心脏再同步化加药物控制心室率治疗慢性心力衰竭伴持续性心房颤动的疗效

The effects of cardiac resynchronization and pharmacological treatment to control ventricular rate in chronic heart failure patients and coexistent persistent atrial fibrillation

目的探讨心脏再同步化(CRT)加药物控制心室率治疗慢性心力衰竭(简称心衰)伴持续性心房颤动(房颤)的疗效,分析该类患者对CRT产生反应的关键原因。方法选择26例心衰合并房颤的患者接受最佳药物及CRT手术治疗。CRT加药物控制心室率16例(药物组),CRT加房室结消融10例(消融组)。随访1.2±0.2年后观察药物组临床参数(NYHA心功能分级,6 min步行距离),QRS波及超声心动图参数[左室射血分数(LVEF)、左室舒张末期内径(LVEDD)]的变化。结果药物组治疗后心功能分级降低(2.0±0.1 vs 3.0±0.2级),6 min步行距离增加(418.9±81.3 m vs 311.5±65.2 m),QRS波时限缩短(138.1±5.6 ms vs 169.6±4.4 ms)及LVEF增加(0.40±0.01 vs 0.23±0.01)、LVEDD减少(61.9±1.6 mm vs 69.0±1.2 mm),药物组起搏比例为0.90±0.04。其疗效与消融组无差异。结论对于心衰伴房颤患者,CRT加药物控制心室率与加房室结消融一样有效。该类患者对CRT产生反应的关键原因是药物良好的控制心室率及较高的双心室起搏比例。

Objective To evaluate the clinical effects and critical reasons of cardiac resynehronization therapy （CRT） in patients with chronic heart failure（CHF） and coexistent persistent atrial fibrillation（AF）. Methods A total of 26 pa- tients were included in the study. All patients were on an optimal medical heart failure regime and CRT.therapy. 16 with chronic AF were on CRT and pharmacological blockade of atrioventricular conduction （ pharmacological group） , 10 with chronic AF underwent CRT and AV nodal ablation （AVNA group）. All patients were followed up for 1.2±0.2 years after the procedure. The changes of clinical parameter （NYHA class, 6-min walk test）, QRS width, left ventrieular ejection frac- tion （LVEF） and left ventricular end-diastolic dimension （LVEDD） were observed. Results In patients with chronic AF were pharmacological blockade of atrioventrieular conduction and CRT therapy, NYHA class improved （2.0±40.1 vs 3. 0±0.2） , 6-rain walk test increased（418.9±81.3 m vs 311.5±65.2 m ） ,QRS width decreased（ 138.1±5.6 ms vs 169.6± 4.4 ms ）, LVEF increased （ 0. 40±0.01 vs 0.23 ±0.01 ） and LVEDD decreased （ 61.9± 1.6 mm vs 69.0~ 1.2 mm）, which showed the clinical effects no significant difference between pharmacological and AVNA group. Conclusion In CHF pa- tients and coexistent persistent AF, CRT therapy and pharmacological blockade of atrioventricular conduction can improve clinical effects as in those with AVNA patients. The key factors influencing the response of CRT in this group is optimized medication to control ventrieular rate and high percentage of biventricular pacing.