充血性心力衰竭患者双室起搏治疗的临床观察

Ventricular re-synchronization therapy in congestive heart failure

目的 观察心室同步起搏对顽固性伴有室内传导或室间隔运动异常的充血性心衰的治疗效果。方法 选择 2 1例 ,其中男 18例 ,女 3例 ,年龄 ( 64± 11)岁 ,合并左束支阻滞的顽固性心衰患者给予双心室同步起搏治疗 ( 16例安装三腔起搏器 ,5例安装三腔心脏自动交律除颤器 )。观察术中、术后 3、6月左室电极的起搏参数 ,同时观察术前、术后 3个月的QRS波时限、LVEF、LVDD、二尖瓣返流量、VO2 max以及临床症状的变化。结果 随访 3～ 2 0个月 ,左室电极的起搏阀值、阻抗及感知各参数值稳定 (P >0 .0 5 ) ,起搏功能良好。与术前相比 ,术后 3个月LVEF等心功能指标均明显改善 (P <0 .0 5 )。随访期间猝死 1例 ,接受心脏移植 1例。结论 心室再同步治疗是治疗存在室间传导异常的充血性心衰的有效的新方法。三腔起搏器可改善患者血流动力学、心功能和心衰的临床症状。左室电极的植入成功率高 ,性能稳定 ,安全可靠。三腔ICD不仅可治疗心衰 。

Objective To assess the therapeutic effect of synchronous biventricular pacing on drug refractory congestive heart failure. Methods A total of 21 patients (18 males, age 64±11 years) with congestive heart failure accompanied by complete left bundle branch block were selected to receive synchronous biventricular pacing (16 cases were implanted with the triple chamber pacemakers with biventricular pacing, 5 cases received the defibrillators(ICD) with biventricular pacing). The pacing parameter of lead in left ventricule, QRS duration, left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter, mitral regurgitation, VO2max and NYHA class of cardiac function were observed before and after operation for up to 20 months. Results All patients were followed up for 3～20 months. The impedance, sensation and pacing thresholds of left ventricular pacing leads were stable after implantation compared with during operation ( P >0.05). The pacemaker and ICD function were satisfactory. LVEF and other parameters of cardiac function were significantly improved 3 months after implantation ( P <0.05) compared with before. There was one case of sudden death during follow up and one patient received cardiac transplantation. Conclusion Ventricular re synchronization therapy is an effective new method for the treatment of congestive heart failure with abnormal inter ventricular conduction. Biventricular pacing can improve the hemodynamics, cardiac function and clinical symptoms. The left ventricular pacing is safe, stable and easy to implant. ICD with biventricular pacing can improve symptoms of heart failure and prevent the sudden cardiac death by effectively acting against ventricular arrhythmia.