不同起搏模式对缓慢性心律失常患者心脏重构及远期预后影响的随访观察  

Effects of ventricular demand and dual-chamber pacing models on the long-term clinical outcome and cardiac remodeling in patients with symptomatic bradycardia

作　　者：董颖雪[1] 郭萌[2] 杨延宗[1] 高连君[1] 查咏梅 解泽宙[1] 张树龙[1] 孙颖慧[1] 王莹琦[1] 夏云龙[1] Javin Boodhna 

机构地区：[1]大连医科大学附属第一医院心内科,116021 [2]安徽省淮南市第一人民医院心内科 [3]美国Mayo Clinic心血管科

出　　处：《中华医学杂志》2011年第30期2103-2107,共5页National Medical Journal of China

摘　　要：目的评价单腔起搏（VVI）和双腔起搏（DDD）对缓慢性心律失常患者心脏重构及远期预后的影响。方法回顾性分析1991年1月至2003年1月植入永久性起搏器的患者的随访资料，评价VVI和DDD两种不同起搏方式患者左心系统重构与瓣膜反流、心脏功能、血栓与心房颤动事件发生率、病死率等影响情况。结果对DDD组患者57例和VVI组患者59例，长期随访（97±27）个月、（107±44）个月发现，DDD组患者左心房、左心室内径同术前比差异无统计学意义[（37±5）mm比（35±5）mm，P=0．07；（47±7）mm比（47±5）mm，P=0．32]，三尖瓣反流率显著增加（42．1％比10．5％，P〈0．01）；VVI组左心房[（45±12）mm比（39±12）mm，P〈0．01]、左心室[（53±11）mm比（50±9）mm，P=0．01）]舒张末期内径较术前明显增加且三尖瓣反流率（42．4％比16．9％，P〈0．01）显著增加；DDD组[（57±7）％比（59％±9）％，P=0．11]和VVI组患者末次随访左心室射血分数[（53±10）％比（56±11）％，P=0．05]同术前比无明显变化；末次随访时DDD组和VVI组心房颤动发生率（5．4％比22．0％，P=0．14）、再住院率（26．3％比33．9％，P=0．08）和病死率（10．5％比11．9％，P=0．77）差异无统计学意义。结论两种起搏模式均不能阻止心脏电重构与机械重构的发生。提示现有的房室顺序起搏模式基础上，有必要寻求更加生理性的起搏部位或最小化心室起搏、优化房室间期等方式提高患者的预后。Objective To assess the effects of VVI （ventricular demand） and DDD （dual- chamber） pacing models on cardiac remodeling and the long-term clinical outcome of patients with symptomatic bradycardia. Methods All patients with DDD and VVI pacing models at our hospital from January 1991 to January 2003 were retrospectively analyzed. Results After a follow-up period of over 8 years in DDD and VVI groups （97 ±27, 107 ±44 months）, left atrial diameter [ （45± 12） mm vs （39 ±12 ） mm, P 〈 0. 01 ] and left ventricular end-diastolic diameter[ （53 ± 11 ） mm vs （50 ± 9） mm, P = 0. 01 ] in 57 patients with VVI pacing model were markedly enlarged than those at pre-implantation. And tricuspid regurgitation increased （42. 4% vs 16. 9%, P 〈0. 05）. But in 59 patients with DDD pacing model, except for increased tricuspid regurgitation（42. 1% vs 10. 5%, P 〈0. 01）, left atrial diameter [ （37 ±5） mm vs. （35 ± 5） mm, P = 0. 07 ] and left ventricular end-diastolic diameter [ （ 47 ± 7 ） mm vs （ 47 ± 5 ） mm, P = 0. 32] were not significantly different. Mitral regurgitation significantly increased only in the VVI group （P 〈 0. 01 ）. The increases of left ventricular end-diastolic diameter （ P = 0. 04）, mitral valve （ P = 0. 02 ） and tricuspid regurgitation （ P 〈 0. 01 ） were much more pronounced in the VVI group than those in the DDD group. Left ventricular ejection fraction （LVEF） showed no difference with that at pre-implantation （P = 0. 11 in DDD group, P = 0. 05 in VVI group）. But the LVEF value was lower （ P = 0.04） while the incidence of thrombolism was higher （P = 0. 03 ） in the VVI group than those in the DDD group at postimplantation. However, the incidence of atrial fibrillation （ P = 0. 14）, hospitalization （ P =0. 08） and survival （P = 0. 77） showed no significant difference between two groups. Conclusion DDD pacing offers more benefits over VVI pacing through improving cardiac functions and arresting left ventricu

关 键 词：起搏器 人工 随访研究 心律失常 心脏重构 

分 类 号：R541[医药卫生—心血管疾病]