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目的报道6例使用双心室优化起搏治疗充血性心力衰竭患者,探讨双心室优化起搏治疗的初步临床经验及V-V起搏间期优化方法。方法自2004年3月起对6例顽固性充血性心力衰竭且药物治疗效果不佳的患者植入了InSyncⅢ(8042型)起搏器。全部患者术前48h之内接受常规超声心动图检查、6min室内平面步行试验(6MHW)、临床心功能评估等作为基础对照。出院前行心室起搏优化确定最佳V-V起搏间期,术后1、3、6个月再次重复上述检查并动态心电图检查,其中第6个月重新优化V-V起搏间期。结果6例患者均顺利完成起搏器植入术。5例患者起搏方式为心房感知并心室起搏,其中总心室起搏数均>90%。1例患者起搏方式为心房感知并心室起搏,其中总心室起搏数为94%。全部患者临床心功能指标(NYHA分级)和6min室内平面步行试验均较术前有显著提高。从双心室优化起搏的即刻效果来看,优化V-V间期使主动脉瓣射血时间-速度积分(VTI)从术前的(20.7±6.6)cm增加至(23.5±6.6)cm。左心室射血分数从术前的0.24±0.09增加至0.29±0.08。结论双心室起搏治疗能改善顽固性充血性心力衰竭且药物治疗效果不佳患者的心功能,提高患者的生活质量,在此基础上进行V-V间期优化可以进一步提高患者的左心室功能。
Objective To report the clinical experience and optimal methods of V-V pacing interval in patients with congestive heart failure treated by biventricular pacing. Methods From March 2004 onwards, InSync Ⅲ (type 8042) pacemaker was implanted in 6 patients with refractory congestive heart failure and poor drug treatment. All patients within 48h before routine echocardiography, 6min indoor walking plan (6MHW), clinical assessment of cardiac function as a baseline control. Ventricular pacing before discharge was optimized to determine the optimal V-V pacing interval. The above examinations and dynamic electrocardiogram were repeated again at 1, 3, and 6 months after surgery. The V-V pacing interval was re-optimized at the 6th month. Results All 6 patients completed pacemaker implantation successfully. The pacing mode of 5 patients was atrial sensing and ventricular pacing, in which the total number of atrial pacing was> 90%. One patient had atrial pacing and ventricular pacing, with 94% of total ventricular pacing. All patients with clinical cardiac function (NYHA classification) and 6min indoor flat walking test were significantly improved compared with preoperative. From the immediate effect of biventricular pacing optimization, the V-V interval was optimized to increase the aortic ejection time-velocity integral (VTI) from preoperative (20.7 ± 6.6) cm to (23.5 ± 6.6) cm. Left ventricular ejection fraction increased from 0.24 ± 0.09 preoperatively to 0.29 ± 0.08. Conclusions Biventricular pacing can improve cardiac function and improve quality of life in patients with refractory congestive heart failure and poor response to drug therapy. V-V interval optimization can further improve left ventricular function in patients.