常规起搏器术后慢性心力衰竭升级为心脏再同步治疗的疗效观察  

Effects of upgrading chronically right ventricle-paced heart failure patients to cardiac resynchronization therapy

作　　者：王丽娟[1] 孙国建[1] 陈建明[1] 何浪[1] 钟诚[1] 吴巧元[1] 沈法荣[1] 

机构地区：[1]浙江省浙江医院心内科,杭州310013

出　　处：《中华心律失常学杂志》2013年第3期192-195,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探讨长期右心室起搏的心力衰竭患者升级为心脏再同步治疗（CRT）后，随访观察临床疗效。方法共22例患者均为长期右心室起搏，并在随访中发现，心功能逐渐下降，左心逐渐增大，符合我国CRT升级适应证，予以升级为CRT，观察术前、术后6个月患者的基线特征变化，QRS时限的变化，以及超声心动图指标变化。结果普通起搏器升级为CRT后，随访6个月，QRs时限明显缩短[（18±19）ms对（142±22）ms，P〈0．001]，左心室射血分数（LVEF）明显升高[（0．33±0．02）对（0．42±0．08），P〈0．001]，左心室收缩末期内径，左心室舒张末期内径均有明显减小。患者平均改善心功能I级（NYHA分级）（P〈0．001）。二尖瓣反流程度也较升级前减轻。比较升级治疗后有反应组和无反应组患者的特点，不合并冠心病的患者较合并冠心病的患者有反应者更多，其余基线资料差异无统计学意义。结论长期右心室起搏的心力衰竭患者升级为CRT后，心功能明显改善。Objective To evaluate the benefit of cardiac resynchronization therapy （CRT）in patients with chronically right ventricle paced heart failure. Methods We studied 22 patients who had a previously implanted pacemaker or implantable cardioverter defibrillator.All these patients were chronically RV paced resulted in a tremendous LV function deterioration and treated by upgrading to CRT or CRT-D.To observe the changes of the baseline character including ORS duration, and echocardiography at least 6 months after upgrading to CRT or CRT-D. Results CRT significantly reduced the mean ORS duration [ （181±19） ms vs（ 142±22）ms,P 〈0.001 ], and increased the LV ejection fraction（（0.33±0.02） vs （0.42±0.08）, P〈0.001 ] .Left ventricular end- systolic and end-diastolic dimensions were reduced significantly. After upgrade to CRT, the patients cardiac function was improved by an average of one grade of NYHA fuctional class（P〈0.001 ）.Mitral regurgitation was also significantly improved.Response to CRT upgrade was independent of the underlying rhythm, QRS duration, duration of prior RV pacing,or LV function at baseline.But the reduction of the QRS duration was associated with CRT response, and patients with ischaemic cardiomyopathy were less likely to respond to CRT than those with nonisehaemic disease. Conclusion This study demonstrated that CRT improved heart function in the patients with chronic right ventricular pacing.

关 键 词：心力衰竭 右心室起搏 心脏再同步治疗 

分 类 号：R541[医药卫生—心血管疾病]