双心腔起搏治疗肥厚梗阻性心肌病患者的长期随访

Assessment of long-term results of dual-chamber pacing in patients with hypertrophic obstructive cardiomyopathy

目的 评价双心腔起搏对肥厚梗阻性心肌病患者的远期疗效。方法 15例确诊为肥厚梗阻性心肌病并植入双心腔起搏器的患者 ,男性 11例 ,女性 4例 ,平均年龄 (5 0 2± 15 5 )岁 ,程控为DDD起搏方式。对患者术前、术后第 1次随访平均 (5 1± 1 6 )个月及最近 1次随访平均(2 7 3± 3 7)个月的临床症状、心功能、和超声心动图下的血流动力学指标进行分析。结果 9例晕厥患者在第 1次评价时即未再发作 ,2例先兆晕厥的患者 ,在第 1次评价时仍有 1例有偶发 ,但在第2次评价时症状也消失。 15例气促、 13例胸痛、 12例心悸患者 ,在第 1次评价时分别有 6例、 7例、6例症状完全消失 ,总消除率约 4 0 %。在第 2次评价时又分别有 5例、 2例、 3例患者症状完全消失 ,进一步症状消除率约 2 0 %。患者左心室流出道跨瓣压差由术前平均 (79 9± 32 6 )mmHg (1mmHg=0 133kPa) ,经半年起搏治疗后降为 (43 2± 18 9)mmHg ,3年后进一步降为 (40 4± 2 4 1)mmHg ,两次结果与术前比较均有统计学意义 (P <0 0 1) ;心功能由术前的 (2 6± 0 4 )级 (NYHA分级 ) ,提高到第 1次随访时的 (1 7± 0 3)级 (P <0 0 1) ,第 2次随访时的 (1 1± 0 2 )级 (P <0 0 1) ;E/A峰值 ,在术前、第 1次随访、第 2次随访时分别为 0

Objective To assess the long term results of dual chamber pacing in patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods Fifteen patients[11 male,mean age of (50 2±15 5)years]with documented HOCM were implanted a permanent dual chamber pacemaker and programmed to DDD mode.Data of clinical symptoms,cardiac function,and hemodynamic parameters obtained from echocardiography were collected before implantation,(5 1±1 6)months and (27 3±3 7)months after implantation,respectively.Results At a mean follow up of(5 1±1 6)months,the syncope attacks were eliminated in all 15 patients,presyncope were eliminated about 93%.The chest pain,dyspnea,and palpitation were also eliminated about 50%,40% and 40%,respectively.At the second evaluation,no syncope or presyncope were complained.And the chest pain,dyspnea, and palpitation were progressively eliminated in 60%,70% and 60% patients,respectively.An average of 10% beneficial effects was obtained from pacing per year. The NYHA cardiac function were also progressively improved significantly from(2 6±0 4)at baseline to (1 7±0 3)at the first evaluation( P <0 01),further to (1 1± 0 2)at the second evaluation ( P <0 01).E/A ratio was also improved from baseline 0 8±0 3,to the first follow up evaluation 1 0±0 5 and the second follow up evaluation 1 2±0 9,but no statistical significance of difference exist among three evaluations( P >0 05).No mitral regurgitation deterioration due to pacing were observed. The hypertrophic interventricular septum were reversed in some extent,reduced from (24 1±6 5)mm at baseline to(21 5±5 1)mm at the first follow up evaluation( P <0 01 vs baseline)and(20 9±4 4)mm at the second follow up evaluation( P <0 01 vs baseline).Conclusions(1)Dual chamber pacing may eliminate the symptoms of most HOCM patients,especially in patients with recurrent syncope or presyncope.It may significantly improve the cardiac function and exersise capacity of HOCM patients.These beneficial effects were also observed in long term follow up period.(2)Long term pacing appears to reverse interventricular septum hypertrophy in some extent.