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基于双腔起搏器右心房-左心室间期实现心脏再同步治疗的可行性研究 被引量:4

The feasibility study of dual chamber pacemaker achieving cardiac resynchronization therapy base on right atrial-left ventricular interval
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摘要 目的探讨双腔起搏系统基于右心房-左心室间期(RAS-LVS)自动优化单左心室起搏房室间期(AVI)实现心脏再同步治疗(CRT)的可行性及算法。方法入选2013年10月至2017年6月收住昆明医科大学第一附属医院心内科,符合CRTⅠA类适应证并植入双腔起搏器的慢性心力衰竭患者(CHF)11例,延长AVI后测定RAS-LVS,基于该间期在超声心动图下优化单左心室起搏的AVI,比较术前及术后间期优化后主动脉前向血流速度时间积分(AVVTI),左心室射血分数(LVEF)、12节段达峰时间标准差(TS-SD12)、主肺动脉射血前时间差(IVMD)、二尖瓣反流面积(MRA)、QRS时限的差异。计算单左心室起搏优化的AVI与RA-LV间期比值(左心室优先系数ε)。结果与术前比较,AVVTI[(22.84±2.15)cm对(16.43±2.31)cm,P<0.05]、LVEF(37.2%±3.88%对27.61%±4.20%,P<0.05)、TS-SD12[(93.92±24.59)ms对(122.06±22.23)ms,P<0.05]、IVMD[(65.27±11.29)ms对(82.64±14.74)ms,P<0.05]、MRA[(3.10±1.12)cm^2对(4.28±1.25)cm^2,P<0.05]、QRS时限[(135±11)ms对(187±21)ms,P<0.05]均明显改善,RAS-LVS为(300±41)ms,优化的AVI为(151±18)ms,ε为0.55±0.09。结论双腔起搏器基于RAS-LVS优化AVI可实现CRT,最佳AVI为RAS-LVS的55%。 Objective To explore the feasibility and algorithm of left univentricular pacing(LUVP)achieving biventricular resynchronization base on right atrial-left ventricular(RAS-LVS)interval in congestive heart failure(CHF)patients planted with dual chamber pacemaker.Methods Eleven patients with CHF who were eligible for Class IA indication of cardiac resynchronization therapy(CRT)in Department of Cardiology,The First Affiliated Hospital of Kunming Medical University form October 2013 to June 2017,were enrolled into this study.Echocardiography was used to optimize atrioventricular interval(AVI)for both groups.Aortic velocity-time integral(AVVTI),left ventricular ejection fraction(LVEF),standard deviation of time intervals of the 12 left ventricular segments(Ts-SD12),interventricular mechanical delay(IVMD),mitral regurgitation area(MRA),duration of QRS complex,average annual cost,improvements in New York Heart Association(NYHA)class,and were compared between pre-operation and post-operation.Results The duration of QRS complex[(135±11)ms vs.(187±21)ms,P<0.05],MRA[(3.10±1.12)cm^2 vs.(4.28±1.25)cm^2,P<0.05],IVMD[(65.27±11.29)ms vs.(82.64±14.74)ms,P<0.05],were significantly less than those of pre-operation.AVVTI[(22.84±2.15)cm vs.(16.43±2.31)cm,P<0.05]and LVEF(37.2%±3.88%vs.27.61%±4.20%,P<0.05)were greater than those of pre-operation.Conclusions It can achieve CRT base on RAS-LVS interval in CHF patients who planted with dual chamber pacemaker,and the most suitable AVI is 55%of RAS-LVS interval.
作者 蒲里津 赵璐露 何忠荣 王钰 华宝桐 代荣俗 丁旭萌 赵玲 Pu Lijin;Zhao Lulu;He Zhongrong;Wang Yu;Hua Baotong;Dai Rongsu;Ding Xurneng;Zhao Ling(Department of Cardiology,The First Affiliated Hospital of Kunming Medical University,Institute of Cardiovascular Diseases,Kunming 650032,China)
出处 《中华心律失常学杂志》 2019年第1期24-27,共4页 Chinese Journal of Cardiac Arrhythmias
基金 国家自然科学基金(81760064).
关键词 心力衰竭 心脏再同步治疗 心脏起搏器 人工 Heart failure Cardiac resynchronization therapy Pacemaker,artificial
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