经胸植入双腔起搏器心脏再同步化治疗儿童特发性CLBBB致心力衰竭五例  

Transthoracic implantation of dual-chamber pacemaker for synchronous treatment of cardiac dysfunction due to idiopathic complete left bundle branch block in children

作　　者：李小梅 刘海菊 江河 崔建 靳永强 张仪 戈海延 Li Xiaomei;Liu Haiju;Jiang He;Cui Jian;Jin Yongqiang;Zhang Yi;Ge Haiyan(Division of Pediatric Cardiology,First Hospital of Tsinghua University,Beijing 100016,China)

机构地区：[1]清华大学第一附属医院心脏中心小儿科,北京100016

出　　处：《中华儿科杂志》2020年第10期828-832,共5页Chinese Journal of Pediatrics

摘　　要：目的探讨经胸植入左心房左心室双腔永久起搏器心脏再同步化治疗对特发性完全性左束支传导阻滞(CLBBB)所致心力衰竭的有效性及可行性。方法回顾性分析自2015年1月至2019年7月因特发性CLBBB导致心力衰竭在清华大学第一附属医院心脏小儿科接受经胸植入左心房左心室双腔永久起搏器的5例患儿的资料。分析5例患儿植入起搏器的效果,超声心动图评估其对心功能和心脏同步性的影响。结果5例患儿中男2例、女3例。植入起搏器时年龄0.5~5.7岁,左心室射血分数(LVEF)29%~46%,左心室舒张末内径30~53 mm,Z值4.0~34.0。5例患儿手术均获成功,术后结合抑制房室结传导药物以及调整感知的房室间期参数设置至左心室起搏比例达97%~100%并QRS波时限最短。5例患儿术前QRS波时限120~160 ms,术后90~120 ms。5例患儿左心室起搏后1 d^1个月心功能开始改善,1个月~1年心功能完全恢复正常,LVEF由29%~46%升至55%~67%。术后随访心室间机械延迟时间、室间隔与左心室后壁收缩延迟时间、左心室内收缩不同步指数均较术前明显减小(分别为31~62 ms比26~50 ms;40~63 ms比10~50 ms;34.3~50.3 ms比16.3~31.4 ms)。左心室整体纵向应变值由-7.7%^-13.8%下降至-13.5%^-20.3%。结论儿童CLBBB发生的心力衰竭,可考虑通过经胸植入左心房左心室双腔起搏器替代三腔起搏器实现同步化治疗效果,使心功能逆转恢复正常。Objective To investigate the efficacy and feasibility of transthoracic implantation of permanent left atrial and left ventricular dual-chamber pacemaker for synchronous treatment of cardiac dysfunction due to idiopathic complete left bundle branch block(CLBBB)in children.Methods The clinical data of five children with cardiac dysfunction due to idiopathic CLBBB and accepting implantation of permanent left atrial and left ventricular epicardial dual chamber pacemaker from January 2015 to July 2019 at the Pediatric Cardiologic Department of the First Hospital of Tsinghua University were analyzed retrospectively.The effects of pacemaker implantation on patients′cardiac function and cardiac synchrony were evaluated by echocardiogram.Results Among 5 patients,2 were males and 3 females.At the time of pacemaker implantation,the age of these patients was 0.5-5.7 years,the left ventricle ejection fraction(LVEF)was 29%-46%,the left ventricle end stage of diastolic diameter was 30-53 mm and the mean Z score was 4.0-34.0.Pacemaker was successfully implanted for all the patients.After the implantation,medications that can suppress atrioventricular node conduction were used and sensed atrioventricular delay(SAV)parameters were modulated until patients′QRS duration became shortest and the percentage of left ventricular pacing increased to and maintained at 97%to 100%.Patients′QRS duration was 120-160 ms before implantation and 90-120 ms after implantation.Patients′cardiac function began to improve 1 day to 1 month after implantation.Patients′cardiac function normalized after a mean of 1-12 months.LVEF increased from 29%-46%to 55%-67%.During the follow-up,interventricular mechanical delay,septal-to-posterior wall motion delay,and left ventricular systolic dyssynchrony index decreased significantly:IVMD decreased from 31-62 ms to 26-50 ms;SPWMD decreased from 40-63 ms to 10-50 ms and Ts-SD decreased from 34.3-50.3 ms to 16.3-31.4 ms.The global longitudinal strain of left ventricle decreased from-7.7%--13.8%to-13.5%--20.

关 键 词：束支传导阻滞 儿童 心脏起搏器 人工 

分 类 号：R726.5[医药卫生—儿科]