希浦系统起搏联合房室结消融改善心房颤动合并心力衰竭患者生活质量的效果

The effect of His-Purkinje system pacing with atrioventricular node ablation on life quality on patients with persistent atrial fibrillation and heart failure

目的探讨希浦系统起搏联合房室结消融治疗对心房颤动合并心力衰竭患者生活质量影响。方法选取2019年1月至2020年5月成功植入希浦系统起搏联合房室结消融治疗持续性房颤合并心力衰竭患者28例,评估希浦系统起搏植入前后生活质量及心功能的变化。结果与植入前相比,起搏器植入术后SF-36各维度评分(除躯体疼痛外)均明显升高(P<0.001),明尼苏达心力衰竭生活质量问卷评分明显下降(P<0.001),心超EF值升高(P<0.001),二尖瓣反流程度减轻(P<0.001)。28例患者中,有射血分数下降(HFrEF)患者10例,希浦系统起搏术后患者LVEF升高(P=0.003),LVEDD减小(P<0.001);射血分数保留(HFpEF)患者18例,希浦系统起搏术后患者LVEF升高(P=0.047)、LVEDD较术前无明显改善。结论对持续性房颤合并心力衰竭患者,希浦系统起搏可提高生活质量,改善心脏功能,这些临床益处在射血分数下降的心力衰竭患者中更为显著。

Objective To explore the effect of His-Purkinje system pacing(HPSP)with atrioventricular node ablation on life quality on patients with persistent atrial fibrillation(AF)and heart failure(HF).Methods We consecutively recruited 28 patients with persistent AF and HF who were successfully implanted with HPSP at Sir Run Run Shaw Hospital,Zhejiang University College of Medicine from January 2019 to May 2020.The changes in quality of life and cardiac function before and after the implantation were evaluated.Results SF-36 scores of all dimensions(except somatic pain)were significantly increased(P<0.001).Minnesota Heart Failure Quality of Life Questionnaire scores were significantly decreased(P<0.001).The LVEF were increased(P<0.001),and MR was reduced(P<0.001).Among all 28 patients,there were 10 patients with HFrEF,the LVEF were significantly increased(P=0.003)and LVEDD were decreased(P<0.001)after pacing.There were 18 patients with HFpEF,the LVEF were significantly increased(P=0.047)and LVEDD were not significantly improvement compared with before operation.Conclusion In patients with persistent AF and HF,HPSP significantly improves the quality of life and cardiac function which is much more significant in patients with HFrEF.