双心室起搏治疗难治性充血性心力衰竭的应用研究

Applied research of biventricular pacing in refractory congestive heart failure

目的 :观察双心室起搏治疗难治性充血性心力衰竭 (CHF)的疗效。方法 :11例难治性CHF患者行双心室起搏。将冠状窦电极或剪去侧翼的普通心室电极置入冠状窦的远端分支实现左心室起搏 ,失败者改用螺旋电极在右室流出道行右室双部位起搏。结果 :双心室起搏后患者心力衰竭症状明显改善 ,心功能分级提高 ,超声和核素检查示心功能指标改善 ,心室收缩协调性增强 ,起搏后QRS波时限缩短 ,运动耐量增加 ,生活质量提高 ,住院频率下降。结论 :房室延迟间期恰当的双心室起搏可提高难治性CHF患者的运动耐量、心肌收缩协调性和生活质量 ,改善患者心功能级别和指标 ,降低心力衰竭患者住院频率和室性心律失常的发生率 ,是CHF有效的治疗手段之一 ,伴有房室和 (或 )

Objective:To observe the efficacy of biventricular pacing in treating refractory congestive heart failure (CHF). Method:Biventricular pacing had been performed in 11 patients. Coronary sinus leads or ordinary ventricular leads with some scissored wings were inserted into the branches of coronary sinus to pace left ventricles. Pacing by screw in leads in right ventricular outflow tract (RVOT) was done if we had failed to cannulate the coronary sinus. Result:Heart functions were remarkably improved after biventricular pacing. The NYHA class of heart function was improved from Ⅲ～Ⅳ to Ⅰ～Ⅱ. The improvement of heart functional parameters was found by echocardiography and radionuclide. The ventricular resynchronization was also showed by radionuclide. After biveatricalar pacing, QRS complexes became narrow, frequency of hospitalization was decreased, and exercise tolerance and quality of life were improved. Conclusion:Exercise tolerance, myocardial resynchronization, quality of life, heart functional class and frequency of hospitalization can be improved by biventricular pacing in optimal AVD. We also find that the best pacing site is the one with the narrowest QRS complexes when pacing. Biventricular pacing can be considered as one of effective ways to deal with refractory CHF, especially to those with atrioventricular and/or intraventricular delay.