生理性起搏对老年缓慢型心律失常伴心功能不全患者的作用

Effects of physiological pacing on cardiac function in elderly with bradycardic arrhythmia

目的 探讨生理性及非生理性起搏对伴有心功能不全的老年缓慢型心律失常患者的作用。方法 在常规强心药物治疗的同时安置永久起搏器。非生理性起搏组 5 4例 ,生理性起搏组 36例 (使用DDD起搏为 12例 )。于术前、术后 1周及术后 6个月时用超声多普勒分别测定心功能参数。结果 生理性起搏组术后 1周时左室射血分数(LVEF)、每搏量 (SV)及心排量 (CO)均明显改善 ,血流加速时间 (AT)缩短 ,主动脉峰值血流速度 (PV)加快。 6个月后上述参数进一步改善 ,左室舒张末期内径 (LVd)亦显著缩小。该组患者术后 1周及术后 6个月时心功能改善情况均明显优于非生理性起搏器。DDD起搏者A V间期为 10 0ms时心功能参数最理想。结论 采用药物 +生理性永久起搏术治疗老年缓慢型心律失常患者的心功能不全 ,可取得满意的近期和远期效果。

Objective To evaluate the effects of physiological and non physiological pacing on cardiac function in elderly with bradycardic arrhythmia.Method VVI pacemaker was implanted in 54 patients(non physiological pacing group).Physiological pacemaker was implanted in 36 patients (12 cases used DDD pacing).LVd,LVEF,SV,CO,peak velocity (PV) and acceleration time(AT) of aortic blood flow were measured by dimensional and pulsed Doppler echocardiography before and 1 week,6 months after implantation.Routine drug treatment was given during cardiac pacing.Results LVEF,SV,CO,AT and PV were significantly improved 1 week after implantation and improved further 6 months after implantation in physiological pacing group.The improvement of hemodynamic variables was not significant in VVI pacing group.The hemodynamic data was optimal when A V delay was set up to 100 ms in patients with DDD pacing.Conclusion Drug treatment plus permanent physiological pacing is effective for heart dysfunction in elderly with bradycardic arrhythmia.