左束支阻滞激动模式：心功能不良重要的可逆性因素  

The excitation mode of left bundle branch block： an important reversible factor of heart failure

作　　者：单其俊[1] 邹建刚[1] 陈椿[1] 杨兵[1] 陈明龙[1] 徐东杰[1] 侯小峰[1] 曹克将[1] 

机构地区：[1]南京医科大学第一附属医院心脏科,210029

出　　处：《中华心律失常学杂志》2009年第1期20-23,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的观察左束支阻滞激动模式对心脏功能和结构的影响。方法3例心功能不良和左心室扩大患者，左心室射血分数（LVEF）0．44±0．11，左心室舒张末内径（LVEDD）（56±4）mm，QRS时限增宽（177±15）ms，呈左束支阻滞或左束支阻滞样图形。例1为风湿性心脏病二尖瓣及主动脉瓣置换术后伴左束支阻滞；例2为显性右侧预激综合征；例324h动态心电图示右心室流出道室性早搏（室早）3万次。结果例l成功行心脏再同步治疗，例2和例3成功行右侧显性旁路和右心室流出道室早消融，QRS时限降至（103±25）ms，随访6～30个月，症状明显改善，心功能恢复正常，左心室明显缩小，LVEF为0．65±0．04和LVEDD（48±4）mm。结论左束支阻滞激动模式是心功能不良重要的可逆性因素。Objective To investigate the effects of excitation mode of left bundle branch block （LBBB） or LBBB-like on the cardiac function and structure. Methods This study included three patients with depressing cardiac function （ LVEF = 0. 44± 0. 11 ） and enlarged left ventricle [ LVEDD = （ 56 ± 4 ） mm ]. The widen QRS complex [ QRS duration = （ 177 ± 15 ）ms] displayed LBBB or LBBB-like was documented in all patients. One patient with serious heart failure had the history of surgical mitral and aortic valves replacement and LBBB. The right ventricular preexcitation and frequent premature ventricular contractions （more than 30 000 beats per 24 hours ） were documented in other 2 patients, respectively. Results The patient with surgical valves replacement and LBBB underwent successful cardiac resynehronization therapy with biventficular pacing. The para-Hisian accessory pathway and premature ventricular contractions originated from right ventricular out- flow tract were ablated successfully in other patients, respectively. After the procedures, the QRS complex be- came significant narrow [ QRS duration = （ 103± 25 ）ms ] in all patients. During the follow-up period of 6 to 30 months,the cardiac function （ LVEF = 0. 65 ± 0. 04） improved obviously and cardiac size reversed to normal [LVEDD = （48 ±4）mm] in all patients. Conclusion The LBBB or LBBB-like excitation mode is an important reversible factor in patients with heart failure.

关 键 词：左束支阻滞 心力衰竭 心脏再同步治疗 

分 类 号：R541[医药卫生—心血管疾病]