顽固性心力衰竭的心室同步化治疗

The effect of synchronous biventricular pacing in patients with refractory heart failure

目的:评价双心室同步起搏对扩张型心肌病顽固性心力衰竭(心衰)的治疗效果。方法:对4例顽固性心衰患者[NYHA Ⅲ～Ⅳ级(LVEF<40%),QRS间期≥150ms,左室舒张末期容积(LVED)≥65 mm],药物治疗效果不佳的顽固性心衰,植入美敦力公司Insync起搏装置,经房室顺序双心室同步起搏,观察起搏前后心功能、LVEF、LVED和6 min步行变化。结果:右心室、右心房、左心室导线起搏和感知参数均符合要求。随访中发现1例冠状窭电极导线轻度移位引起呃逆,经调整位置后消失,未发现其他导线移位和功能障碍。植入后一个月双室起搏后ORS时限比单室起搏或未起搏明显缩短,LVEF提高,LVED缩小,6min步行距离增加。结论:双心室同步起搏治疗顽固性心衰可以缓解患者症状,改善心功能,这可能与心室间电活动以及机械活动的再同步化有关。

Objective:To assess the impact of biventricular pacing on refractory heart failure in patients with dilated cardiomyopathy or ischemic cardiomyopathy. Methods: Biventricular synchronous pacing were performed in 4 selected refractory heart failure patients with NYHA heart function class III - IV ,LVEF<40% ,QRS widens 150 ms and LVED>65 mm. Serial LVEF, NYHA class of heart function, LVED and 6 minite hall walk were evaluated by atrio-biventricular pacing Insync device (Mdetronic) before and after implanting procedure. Results: The acute pacing and sensing thresholds of implanting right atrial and biventricular leads were normal except one 2187 coronary sinus lead was dulocalization after 3 days of implantation. Hiccup occurred in this patient and disappeared after re-localization by operation. After 2 weeks of implantation there were also improvement in heart failure symptoms. The QRS duration was significantly shortened by biventricular pacing in comparison with baseline, right ventricular pacing or left ventricular pacing. LVEF increased and LVED decreased, 6-minute hail walk improved steadily. Conclusion: Biventricular pacing reverse interventricular electro-mechanical asynchrony so that it can improve heart function and maybe improved prognosis of the patients with refractory heart failure.