心脏再同步化治疗慢性心力衰竭伴持续性心房颤动的疗效  

Efficacy of cardiac resynchronization therapy in chronic heart failure patients with persistent atrial fibrillation

作　　者：韦德宇[1] 丁晓梅[1,2] 孙贤林[1,2] 严激[1,2] 徐健[1,2] 范西真[1,2] 苏浩[1,2] 

机构地区：[1]安徽医科大学附属省立医院心内科,安徽合肥230001 [2]安徽省心血管病研究所

出　　处：《中国心脏起搏与心电生理杂志》2011年第2期123-125,共3页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的评价心脏再同步化治疗(CRT)慢性心力衰竭(简称心衰)合并持续性心房颤动(简称房颤)患者的临床疗效。方法选择慢性心衰患者53例,其中42例窦性心律患者及11例房颤患者接受双心室起搏治疗,术后3个月进行随访,观察患者的心功能分级,6 min步行距离,超声心动图测定各房室腔内径大小、左室射血分数(LVEF)、二尖瓣返流以及速度向量成像超声评价同步性参数的变化。结果 53例三腔起搏器置入术均取得成功。与术前相比,术后3个月房颤CRT患者心功能分级(2.30±0.47级vs 3.0±0.02级)、左房内径(44.9±3.8 mm vs52.2±4.2 mm,P<0.05),LVEF(0.43±0.02 vs 0.32±0.03)及二尖瓣返流(1.5±0.2 vs 3.18±1.75,P<0.01)均有明显改善,速度向量成像超声结果显示,室内不同步较术前有明显改善。窦性心律患者术后各项心功能及不同步指标较术前亦有明显改善,与房颤CRT患者比较差异无显著性。结论对于慢性心衰合并持续性房颤患者,CRT与窦性心律一样可以改善心功能。Objective To evaluate the clinical efficacy of cardiac resynchronization therapy （CRT） in patients with chronic heart failure （CHF） and persistent atrial fibrillation （AF）. Methods The investigation included 53 chronic heart failure patients, 42 in sinus rhythm（SR） and 11 in AF underwent CRT. All patients were followed up for 3 months after the procedure. The heart function class （NYHA）, 6 min walking distance, and echocardiographie ventricular cavity diameter measured by size, LVEF, mitral regurgitation, and velocity vector imaging ultrasound evaluation of synchronization parameter changes were observed . Results Pacemaker implantation were successful in all patients. At 3 months of fol- low-up , NYHA function class （2.30 ±0. 47 vs 3.0 ± 0.02, P 〈 0.05 ）, left atrial diameter（LAD） （ 44.9 ±3.8 mm vs 52.2 ± 4.2 mm, P 〈 0. 05 ）, LVEF（0. 43 ±0.02 vs 0. 32 ±0. 03, P 〈 0.01 ） and the degree of mitral reflux （ 1.5 ±0.2 vs 3.18 ±1.75, P 〈0.01 ） were significantly improved in 11 cases with AF. The index of the intraventricular synchronization was also improved signifficanfly. The cardiac function and asynchronous constration indexes were obviously improved in sinus rhythm patients after CRT,which showed no significant difference with that in AF patients. Conclusion CRT can improve heart function in CHF patients with persistent AF as in those with sinus rhythm.

关 键 词：心血管病学 心力衰竭 心房颤动 心脏再同步化治疗 

分 类 号：R541.75[医药卫生—心血管疾病] R541.61[医药卫生—内科学]