永久性心脏起搏器植入早期左心室重构的研究

STRUCTURAL REMODELING OF LEFT VENTRICLE IN EARLY STAGE AFTER PACEMAKER IMPLANTATION

目的 分析起搏器植入后早期左心室重构特点。方法 全组患者27例,其中,起搏心室感知心室R波抑制 型(VVI)起搏器组15例,起搏双腔感知双腔P波/R波抑制型(DDD)起搏器组12例。采用双探头门控单光子发射 计算机断层摄影系统(GSPECT)采集心肌显像资料,测定患者起搏器植入前及植入后随访时(随访期4.6±1.5个 月)自身心律状态时下列左心室参数值:左心室射血分数(LVEF),左心室舒张末容积(EDV),左心室收缩末容积 (ESV)。EDV增加或降低10％及以上者,为重构。结果 13例(48.1％)出现重构,VVI组10例(66.7％),DDD组 3例(25％)。其中,EDV增大7例(25.9％),VVI组5例(33.3％),DDD组2例(16.7％);EDV减少者6例 (22.2％),VVI组5例(33.3％),DDD组1例(8.3％)。结论 起搏器植入后早期,即可出现左心室重构,表现在 EDV增大或缩小。本研究提示,永久性心脏起搏器植入在获得电生理学益处的同时,可能对左心室结构带来某些 不利影响。

Objective To assess the characteristics of structural remodeling of left ventricle in early stage after pacemaker implantation by gated single photon emission computed tomography (GSPECT). Methods The left ventricular ejection fraction (LVEF) ,end - diastolic volume (EDV) and end - systolic volume (ESV) in autologous rhythm were collected by the GSPECT before implantation of pacemaker ,and at follow-up (4.6-1. 5months) in 27 patients. Among them,15 cases were implanted with VVI pacemaker, and 12 cases with DDD pacemaker. The structural remodeling was defined as that EDV increased or decreased 10% pre- and post- implantation. Results 13 cases (10 cases with VVI pacemaker and 3 cases with DDD pacemaker) appeared EDV change, which increased in 7 cases (5 cases with WI pacemaker and 2 cases with DDD pacemaker) and decreased in 6 cases (5 cases with WI pacemaker and 1 cases with DDD pacemaker). Conclusion The structural remodeling of left ventricle appeares in early stage after the implantation of pacemaker with EDV increased or decreased. It suggest that the pacemaker can bring benefits in the early stage after transplantation but in the mean time it may be accompanied with some unfavorable effects on the structure of left ventricle.