应用双腔起搏器频率适应性房室延迟实现双室收缩再同步超应答一例报道并文献复习  

Super-response to Biventricular Systolic Resynchronization Achieved by Dual-chamber Pacemaker Implantation with Rate Adaptive Atrio-ventricular Delay: Report of One Case and Literature Review

作　　者：赵璐露 蒲里津[1] 赵玲[1] 王钰[1] 华宝桐[1] 郭涛[1] 

机构地区：[1]昆明医科大学第一附属医院心内科云南省心血管病研究所,云南省昆明市650032

出　　处：《中国全科医学》2017年第4期501-503,共3页Chinese General Practice

基　　金：国家自然科学基金资助项目(81360044);云南省科技厅-昆明医科大学联合专项基金资助项目(2013FB133)

摘　　要：本文报道了1例诊断为扩张型心肌病的患者,通过双腔起搏器单左心室起搏运用频率适应性房室延迟(RAAV)功能实现心脏再同步化治疗(CRT)。通过术后6个月随访,QRS波时限由术前170 ms变窄为术后118 ms,左心室舒张末内径(LVDd)由术前78 mm缩小为术后49 mm,左心室射血分数(LVEF)由术前32%升高为术后48%,心胸比由术前0.64减小为术后0.55,美国纽约心脏病学会(NYHA)心功能分级由术前Ⅲ级降低为术后Ⅰ级,左房室瓣反流面积(MRA)由术前14.0 cm^2减少为术后1.8 cm^2,左心室12节段达峰时间标准差(TS-SD12)由术前150 ms减少为术后77 ms,主、肺动脉射血时间差(IVMD)由术前47 ms改善为术后33 ms,达到超应答标准。同时结合文献复习,以提高临床医生对双腔起搏器通过RAAV实现双室收缩再同步的认识和应用。This article reported the positive treatment outcome of 1 patient diagnosed with dilated cardiomyopathy achieved by cardiac resynchronization therapy（CRT） via left ventricular pacing with dual-chamber pacemaker implantation and rate adaptive atrio-ventricular（RAAV） delay. The results of 6-month follow-up showed that the general conditions of the patient were significantly improved,and a super-response to biventricular systolic resynchronization was achieved,which mainly manifested in the following： QRS complexes duration was shortened from 170 ms to 118 ms, left ventricular end-diastolic diameter（LVDd） was decreased from 78 mm to 49 mm,left ventricular ejection fraction（LVEF） was increased from 32% to48%,the cardiothoracic ratio value was decreased from 0. 64 to 0. 55,New York Heart Association（NYHA） cardiac functional grading was reduced from level Ⅲ to level Ⅰ,the mitral valve regurgitation area（MRA） was decreased from 14. 0 cm2 to 1. 8cm2,the standard deviation of the time to regional peak systolic velocity of the 12 left ventricular segments（TS-SD12） was decreased from 150 ms to 77 ms,the interventricular mechanical delay（IVMD） was decreased from 47 ms to 33 ms. Meanwhile,the corresponding literature was reviewed,all in order to improve the clinical understanding and application of using the dual-chamber pacemaker with RAAV to achieve CRT.

关 键 词：心力衰竭 心脏再同步疗法 双腔起搏器 生理性起搏 频率适应性房室延迟 

分 类 号：R541[医药卫生—心血管疾病]