心脏再同步治疗超反应者停止起搏研究  

Cessation of pacing in super responders of cardiac resynchronization therapy

作　　者：梁义秀[1,2] 王青青[1,2] 宿燕岗[1,2] 秦胜梅[1,2] 汪菁峰[1,2] 陈学颖[1,2] 王蔚[1,2] 柏瑾[1,2] 葛均波[1,2] 

机构地区：[1]复旦大学附属中山医院心内科,200032 [2]上海市心血管病研究所

出　　处：《中华心律失常学杂志》2016年第2期100-104,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的研究心脏再同步治疗（CRT）术后超反应者停止起搏后，临床症状、心电重构、左心室结构与功能变化。方法连续入选2004年11月至2014年9月在复旦大学附属中山医院行CRT且非起搏依赖的患者并根据随访资料筛选超反应者，随机分配为停止起搏组和继续起搏组，停止起搏组患者予关闭心房与双心室起搏功能，随访3个月与6个月，分别记录患者心功能（NYHA分级），明尼苏达生活质量评分（QOL评分）、6min步行距离（6MWD）、体表心电图QRS时限（QRSd）和超声心动图测定左心室收缩末期容积（LVESV）、左心室舒张未期容积（LYEDV）和左心室射血分数（LVEF），对比停止起搏组与继续起搏组间差异。结果入选超反应者21例，停止起搏组11例，继续起搏组10例，心力衰竭（心衰）症状轻至中度（NYHA分级1.90±0．70），LVEF基本正常0．56±0．09，组间基线资料差异无统计学意义。停止起搏后3个月，停止起搏组与继续起搏组患者比较，NYHA分级、QOL评分、6MWD、QRSd、LVESV、LVEDV和LVEF差异均无统计学意义（P〉0．1）；与研究初始状态比较，停止起搏组和继续起搏组各终点参数变化差异无统计学意义（P〉0．1）。停止起搏后6个月，停止起搏组与继续起搏组患者相比，NYHA分级、QOL评分、6MWD、QRSd、LVESV和LVEDV差异无统计学意义（P〉0．05），停止起搏组LVEF显著低于继续起搏组（0．05±0．01对0．06±0．01，P=0．04）；与研究初始状态比较，停止起搏组LVEF显著下降（0．49±0．10对0．54＋0．06，P=0．04），LVESV临界增加[（49．97±23．41）ml对（43．18±16．87）ml，P=0．05]，其他终点参数变化差异无统计学意义（P〉0.1）。结论CRT超反应者停止起搏6个月后，LVEF显著下降，但临床症状与左心室结构暂时无显著恶化。CRT超反应者应接受长期双心室起搏。Objective To study changes in clinical symptom, cardiac electoral remodeling, and left ventricular structure and function after cessation of pacing in super responders of cardiac resynchronization ther- apy（CRT）. Methods Super responders were recruited from patients receiving CRT between November 2004 and September 2014 without pacing-dependence, and randomized to ceased-pacing group and continued-pa- cing group. NYHA class, Minnesota questionnaire （ QOL）, 6 minute walking distance （ 6 MWD ）, QRS dura- tion （QRSd） , left ventrieular end systolic volume （ LVESV ） , left ventrieular end diastolic volume （LVEDV） and left ventricular ejection fraction（LVEF） were recorded and compared between groups after 3 and 6 months. Results Twenty-one super responders were recruited and randomized,with 11 in ceased-pacing group and 10 in continued-pacing group.No statistically significant difference was identified between groups regarding to NY- HA class, QOL, 6 MWD, QRSd, LVESV, LVEDV and LVEF after 3 months （ all P〉 0. 1 ）.No statistically signifi- cant difference was identified between groups regarding to NYHA class, QOL, 6 MWD, QRSd, LVESV and LV- EDV after 6 months（ all P〉0. 05） ;however, LVEF was significantly lower in ceased-pacing group than that of continued-pacing group （ 0. 05± 0. 01 vs. 0. 06 ± 0.01, P = 0. 04 ）, and LVEF was significantly reduced in ceased- pacing group compared to that at randomization. Conclusion LVEF was significantly reduced in super re- sponders of CRT after 6 months cessation of pacing, with no significant changes in clinical symptoms and left ventricular structure.Even super responders of CRT should receive long-term pacing therapy.

关 键 词：心脏再同步治疗 超反应者 停止起搏 

分 类 号：R541.6[医药卫生—心血管疾病]