【摘要】 目的:探讨双腔起搏器利用频率适应性房室延迟功能行右房-左室起搏治疗慢性充血性心力衰竭(congestive heart failure,CHF)的临床疗效。方法:入选12例符合行心脏再同步化治疗(cardiac resynchronization therapy,CRT)Ⅰa类适应证的CHF患者,NYHA(new york heart association)分级Ⅲ-Ⅳ级,男10例、女2例,所有患者植入具有频率适应性房室延迟(rate adaptive atrio-ventricular,RAAV)功能的双腔起搏器,模式为右房-左室起搏,通过RAAV算法跟踪生理性房室延迟(atrial ventricular delay,AVD)达到双心室再同步。观察起搏治疗前、治疗后左室舒张末期内径(left ventricular end diastolic diameter,LVDd)、左室射血分数(left ventricular ejection fraction,LVEF)、二尖瓣返流面积(mitral regurgitation area,MRA)、左室12节段达峰时间标准差(standard deviation of time intervals of the 12 left ventricular segments,TsSD12)等指标。结果:患者的LVEF由术前的平均(0.27±0.04)提高至术后12个月的平均(0.37±0.02)(P<0.05);LVDd由术前的(79.10±11.50)mm下降至(65.25±10.90)mm(P<0.05);MRA由术前的(3.91±1.14)m2下降至(3.14±1.03)m2(P<0.05);Ts-SD12由术前的(106.20±21.51)ms减少至(87.41±15.50)ms(P<0.05)。结论:双腔起搏器行右房-左室起搏,通过RAAV功能可较好达到心脏再同步化治疗效果,患者心功能可明显改善。更多还原

【Abstract】 Objective: To explore the effect of biventricular resynchronization in right atrial-left ventricular pacing by rate adaptive atrio-ventricular( RAAV) delay in patients with congestive heart failure( CHF). Methods: 12 patients with CHF( NYHA Ⅲ-Ⅳ grade) who were eligible for Class Ia indication of cardiac resynchronization therapy( CRT) were enrolled into this study. 10 males and 2 females were implanted in dual chamber pacemaker with RAAV,with biventricular resynchronization completed via RAAV delay for the track of physiological atrial ventricular delay( AVD) in the mode of right atrium-left ventricular pacing. Left ventricular end diastolic diameter( LVDd),left ventricular ejection fraction( LVEF),mitral regurgitation area( MRA),standard deviation of time intervals of the 12 left ventricular segments( Ts-SD12) and other relevant indexes,were observed before and after pacing therapy. Results: The mean LVEF increased from( 0. 27 ± 0. 04) before operation to( 0. 37 ± 0. 02)1 year after operation( P < 0. 05); the LVDd decreased from( 79. 10 ± 11. 50) mm before operation to( 65. 25 ± 10. 90)( P < 0. 05); MRA decreased from( 3. 91 ± 1. 14) m2to( 3. 14 ± 1. 03) m2( P < 0. 05); Ts-SD12 decreased from( 106. 20 ± 21. 51) ms to( 87. 41 ± 15. 50) ms( P <0. 05). Conclusion: The dual chamber pacemaker with RAAV can be used to complete cardiac resynchronization through right atrial-left ventricular pacing,which can significantly improve cardiac function in patients with congestive heart failure.更多还原