最小化心室起搏策略在病态窦房结综合征合并心衰患者中的临床应用  

Impacts of different strategies to minimize ventricular pacing in patients with heart failure

作　　者：刘如辉[1] 蒋金法[1] 许嘉鸿[1] 宋浩明[1] 方宏[1] 徐文俊[1] 

机构地区：[1]同济大学附属同济医院心内科,上海200065

出　　处：《国际心血管病杂志》2013年第4期252-255,共4页International Journal of Cardiovascular Disease

摘　　要：目的:比较心室起搏管理(managed ventricular pacing,MVP)和固定长房室间期(fixed long AV)两种最小化心室起搏策略,对双腔起搏器植入的病态窦房结综合征合并心衰患者中远期心脏结构和功能的影响。方法:入选70例因病态窦房结综合征植入双腔起搏器的心衰患者,随机分为MVP组和固定长AV间期组,采用右室心尖部起搏方式,植入双腔起搏器后分别启用MVP模式和固定长AV间期模式。规范随访12个月后,比较两组患者心室起搏比例差异以及相应的心超参数变化和6 min步行试验结果。结果:MVP组心室起搏比例较固定长AV间期组心室起搏比例明显减少(1.0%对11.3%,P<0.01);固定长AV间期组左室射血分数术后12个月明显下降、E/A比值降低,而MVP组心功能指标则没有明显变化。术后12个月固定长AV组患者6 min步行距离明显缩短,而MVP组无明显缩短。结论:因病态窦房结综合征植入双腔起搏器的心衰患者,在右心室心尖部起搏状态下,MVP模式较固定长AV间期模式对患者长期的心脏收缩和舒张功能负性影响较小。Objective： To evaluate cardiac function changes in patients with heart failure, who received dual chamber pacemaker implantation between two algorithms： managed ventricular pacing （MVP） and fixed long AV because of sick sinus syndrome. Methods： A total of 70 patients receiving permanent dual chamber pacemaker for sick sinus syndrome were divided into MVP group and fixed long AV group randomly. Managed ventricular pacing or fixed long AV algorithm was used accordingly after the pacemaker was implanted. The percentages of ventricular pacing,index of echocardiography and 6 minutes walking distance were recorded before the operations and after 12-month follow-up. Results： The percentages of ventricular pacing were lower in MVP group than in fixed long AV group （1.0 % vs. ll. 3%0 ,P〈0.01）. The LVEF falled and the E/A ratio decreased in the fixed long AV group after 12- month follow up, yet the MVP group had no statistically significant changes. The 6 minutes＇ walking distance decreased in the fixed long AV group apparently while the MVP group had no significant change. Conclusion： MVP algorithm has less influence than fixed long AV algorithm on the heart systolic and diastolic functions of patients who had heart failure and received dual chamber pacemaker implantation because of sick sinus syndrome.

关 键 词：病态窦房结综合征 心力衰竭 心室起搏管理模式 固定长AV间期模式 

分 类 号：R541.7[医药卫生—心血管疾病]