心脏再同步化治疗的反应性对P波离散度及高频心房事件的影响

Influence of cardiac resynchronization therapy on P wave dispersion and atrial high-rate episodes

目的观察心脏再同步化治疗（CRT）对心力衰竭（HF）患者P波离散度（Pd）和心房高频事件（AHRE）的影响。方法选取2010年1月~2014年5月本院心内科收治的49例行CRT的HF患者，于术前、术后6个月和12个月行12导联心电图、动态心电图、超声心动图检查并定期随访，根据术后6个月NYHA心功能分级和超声心动图结果分为CRT有反应组和无反应组。结果有反应组33例（67%），无反应组16例（33%），与术前相比较，术后6个月，有反应组左室舒张末期内径（LVEDD）显著缩小，左室射血分数（LVEF）显著提高，室性早搏（VPB ）显著减少（P〈0.05），左房最大内径（LAD）、Pd、房性早搏（APB）、AHRE差异未见统计学意义，术后12个月，有反应组除LVEDD显著缩小，LVEF显著升高，VPB显著减少外（P〈0.05）， LAD、Pd显著减小、APB、AHRE显著减少（P〈0.05）。无反应组术后6个月和12个月各参数与术前相比均未见统计学差异，有反应组术后12个月内总AHRE次数与术前Pd呈显著正相关（r=0.651，P=0.000），而与术前LAD无显著相关性（r=0.169，P=0.060）。结论CRT中远期效果可以改善心房重构和Pd、减少AHRE的发生，Pd是CRT后发生AHRE的强有力的预测因子。

AIM To observe the impact of cardiac resynchronization therapy （CRT） on P wave dispersion （Pd） and atrial high-rate episodes （AHRE） in patients with chronic heart failure. METHODS Forty- nine patients with chronic heart failure in our department from January 2009 to May 2014 were included in this study. Patients underwent CRT, 12-lead resting ECGs, 24-h Holter and echocardiograms before CRT, and 6 and 12 months after CRT. Follow-up clinic visits were required. Based on NYHA grade and echocardiograms 6 months after CRT, patients were divided into response group and non-response group. RESULTS Thirty-three patients were assigned to response group and 16 to non-response group. Six months after CRT, LVEDD and ventricular premature beats （VPB） decreased and LVEF increased sig- nificantly in response group, whereas no significant differences were found in LAD, Pd, atrial premature beats （APB） and AHRE, compared with the baseline. Twelve months after CRT, LAD, Pd, APB and AHRE in response group also demonstrated significant improvement in addition to LVEDD, VPB and LVEF. However, no significant differences in non-response group were found in the above indexes 6 and 12 months after CRT. AHRE within 12 months after CRT in response group correlated positively with Pd （r =0. 651, P =0. 000） and no significant correlation was found with LAD （r =0. 169, P =0. 060）. CONCLUSION CRT can restrain the remodeling of atrium and decrease P wave dispersion and AHRE. P wave dispersion may be a strong predicting factor for AHRE after CRT.