四腔起搏治疗充血性心力衰竭伴房间和室内传导延迟的一年随访

The Follow-Up of Four Chamber Pacing in Congestive Heart Failure Companying With Intraatrial Conduct Delay and Intraventricular Block.

研究四腔起搏治疗充血性心力衰竭 (CHF)伴房间和室内传导阻滞的可行性及有效性。患者男性、70岁 ,反复发作CHF 5年 ,心功能进行性恶化伴房间和室内传导阻滞、阵发心房颤动 (AF)、NYHA分级Ⅳ级。采用Medtronic公司生产普通心房 (45 2 3)、心室电极 (40 2 3)和两根冠状窦电极 (2 188)和法国Ela公司生产的BrioDR 2 12型双腔起搏器。两根冠状窦电极分别经冠状窦进入心后侧静脉和心中静脉开口处 ,起搏左室和左房 ;右房、右室电极置于常规位置。起搏方式 :DDTAV。结果 :术后随访一年 ,不用药亦无房性心律失常发生 ,胸闷、憋气症状明显改善。术后二个月 6min步行距离明显延长 (2 0 0→ 710m)。术后一年各项活动基本不受限。超声心动图 (UCG)提示 :左室各壁运动呈向心性同步收缩。左室舒张末径缩小 (75 .8→ 6 4.4mm) ,左室射血分数增加 (0 .2 9→ 0 .33)。二尖瓣返流量减少(5 .0 6→ 3 .6 2m/s) ,NYHA分级Ⅰ～Ⅱ级。结论 :四心腔起搏治疗严重CHF伴房间和室内传导阻滞患者是可行的、安全的 ,近期疗效显著。双房同步起搏有助于预防AF复发 。

A 70 years old man,who had been suffering from remittent congestive heart failure(CHF) (NYHA function class IV) and companying with intraatrial conduct delay and intraventricular block and frequent atrial fibrillation for 5 years.His heart function got progressively deteriorated.A four chamber pacing was implanted,which included Medtronic atrail lead (4523),ventricular lead (4023) and Ela dual chamber pacing (Brio DR 212).The coronary sinus leads were placed via sinus coronarius on the opening of posterolateral vein and middle cardiac vein respectively pacing left ventricular and left atrium,right ventricular and right atrium lead was placed on conventional site,setting the mode as DDTAV.Results:Following the patient for 1 year there was no atrial arrythmia without taking antiarrythmia drug.His symptom of chest distress improved markedly.The walking distance of 6 minutes two months after operation increased obviously (200→710 m),and his activity was not restricted.Echocardiography indicated that the motion of left ventricle(LV) appeared centripetalism and tended to be uniform.LVEDD decreased (75.8→64.4)and LVEF increased(0.29→0.33).The volume of mitral regurgitation decreased(5.06→3.62m/s).His function class was reduced to NYHA Ⅰ～Ⅱ.Conclusion:It is feasible and safe to use four chamber pacing in treating CHF companying with intraatrail conduct delay and intraventricular block.Its short term effect is notable.Dual atrium synchrony pacing contribute to prevent recurrence of atrial fibrillation.Dual ventricular synchrony pacing make the heart function improved obviously.