左心室辅助装置对晚期扩张型心肌病患者心脏电生理的影响  

Electrophysiological alterations after left ventricular assist device implantation in patients with end-stage dilated cardiomyopathy

作　　者：赵泽原 王志华[1] 胡俊龙[1] 孙俊杰[1] 王圣[1] 程兆云[1] ZHAO Zeyuan;WANG Zhihua;HU Junlong;SUN Junjie;WANG Sheng;CHENG Zhaoyun(Department of Cardiac Surgery,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou,451464,China)

机构地区：[1]郑州大学华中阜外医院心外科,郑州451464

出　　处：《临床心血管病杂志》2024年第1期21-25,共5页Journal of Clinical Cardiology

基　　金：河南省医学科技攻关计划项目(No:SBGJ202101005);河南省医学科技攻关计划联合共建项目(No:LHGJ20220111)。

摘　　要：目的:探讨晚期扩张型心肌病患者行左心室辅助装置(left ventricular assist device, LVAD)植入术后心脏电生理的变化。方法:回顾性分析2018年5月—2023年3月于我院接受LVAD植入术的16例晚期扩张型心肌病患者的临床资料。比较术前、术后1 d以及术后1个月体表同步12导联心电图的变化。结果:LVAD植入术后1 d,肢体同步12导联心电图的QRS波群持续时间从(146.6±39.8) ms减少到(133.9±35.3) ms(P<0.05),绝对QT间期持续时间从(412.6±59.6) ms增加到(429.8±52.7) ms(P<0.05),心率校正QT间期(QTc)持续时间从(491.7±37.2) ms增加到(507.8±34.4) ms(P<0.05)。LVAD植入术1个月以后,QT间期持续时间从(429.8±52.7) ms减少到(383.3±44.4) ms, QTc持续时间从(507.8±34.4) ms减少到(468.7±29.3) ms(均P<0.05)。结论:LVAD植入后急性左心室卸负荷使QRS波持续时间减少,QTc间期持续时间增加。LVAD植入后延迟出现的QTc时间减少可能与心脏持续卸负荷期间的电生理逆向重构有关。Objective To investigate the electrophysiological alterations after left ventricular assist device(LVAD)implantation for treating end-stage dilated cardiomyopathy.Methods The clinical data of 16 patients who received LVAD implantation due to end-stage dilated cardiomyopathy in our hospital from May 2018 to March 2023 were retrospectively analyzed.Electrocardiogram examinations were performed before,1 day,and 1 month after LVAD implantation to monitor and evaluate changes in 12-lead electrocardiograms.Results The absolute QT duration[(412.6±59.6)ms vs(429.8±52.7)ms,P<0.05],the heart rate-corrected QT interval(QTc)[(491.7±37.2)ms vs(507.8±34.4)ms,P<0.05]were significantly increased at 1 day post LVAD implantation as compared to before LVAD implantation.However,the QRS duration[(146.6±39.8ms)vs(133.9±35.3)ms,P<0.05]was significantly reduced than that before LVAD implantation.With sustained cardiac unloading via LVAD support,there was a marked decrease in the absolute QT duration[(412.6±59.6)ms vs(383.3±44.4)ms,P<0.05]and QTc[(507.8±34.4)ms vs(468.7±29.3)ms,P<0.05]after 1 month of LVAD implantation.Conclusion Electrocardiogram results show that LVAD could effectively reduce left ventricular load,decrease the QRS duration and increase the absolute QT and QTc duration.Delayed decreases in QTc after LVAD implantation may be related to the reversal of electrophysiologic remodeling during the continued unloading period of the heart.

关 键 词：心力衰竭 终末期 左心室辅助装置 人工心脏 心电图 扩张型心肌病 

分 类 号：R542.2[医药卫生—心血管疾病]