房室结消融加上双心室起搏治疗心力衰竭伴心房颤动患者

Clinical application of atrio-ventricular node ablation and biventricular pacing in patients with congestive heart failure complicated with chronic atrial fibrillation

目的 观察了8例充血性心力衰竭伴心房颤动(房颤)患者进行房室结消融后,植入双心室起搏器的治疗效果。方法 8例充血性心力衰竭伴持续性房颤患者,男性5例,女性3例,平均年龄58.4岁,平均左心室内径(68.5±6.3)mm,左心室射血分数(LVEF)0.30±0.03,所有患者均伴有室内阻滞,平均QRS宽度(157.1±22.3)ms。患者先进行射频导管消融阻断房室结(希氏束),然后进行双心室起搏器植入术。在冠状静脉窦造影术后,经冠状静脉窦植入左心室起搏电极导线至一根心脏静脉,通常是心脏后侧静脉或心脏后静脉内。右心室起搏导线置于右心室心尖部,然后与双心室起搏器连接。结果 8例患者均成功地消融房室结,植入双心室起搏器术后超声心动图显示,LVEF从术前的0.30提高至0.38(P<0.05),二尖瓣返流较术前明显减少,患者临床上心慌、气短症状明显改善,心功能(NYHA分级)平均改善Ⅰ级。结论 初步临床观察提示,对于充血性心力衰竭伴有房颤患者,双心室同步起搏同样可改善患者心功能。

Objective To observe the clinical effect of biventricular pacing in patients with congestive heart failure complicated with chronic atrial fibrillation. Methods There were 8 patients, 5 male and 3 female, mean age of 58.4 years old, with refractory chronic heart failure complicated with chronic atrial fibrillation. The mean QRS width was(157.1±22.3)ms. All of them received atrio-ventricular junctional catheter ablation and biventricular pacing. Results After biventricular pacing, the heart function was significantly improved. The LVEF increased from 0.30 to 0.38 (P<0.05). The left ventricular filing time increased and mitral regurgitation reduced. The NYHA class of the patients was improved Ⅰ class. Conclusion The biventricular pacing could improve heart function in patients with congestive heart failure complicatd with chronic atrial fibrillation.