【摘要】 目的:探讨频率适应性房室延迟功能在双腔起搏器行右房-左室(RA-LV)起搏治疗慢性充血性心力衰竭(congestive heart failure,CHF)中的临床疗效。方法:选择30例符合心脏再同步化治疗(cardiac resynchronization therapy,CRT)Ⅰa类适应证的CHF患者(NYHA分级Ⅲ-Ⅳ级),随机分为右房-左室起搏(RA-LV)组及双室起搏(Biv)组,各15例。RA-LV组患者植入带频率适应性房室延迟(rate adaptive atrio-ventricular,RAAV)功能的双腔起搏器,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;Biv组植入三腔起搏器行双室起搏。观察两组患者起搏治疗前、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,Ts-SD12)、EA峰间距(E/A peak period,E/Apd)、主、肺动脉射血时间差的变化及QRS波时限、电池寿命、6 min步行试验(six minutes walk test,6 MWT)等指标。结果:与Biv组比较,RA-LV组QRS波时限较短(P<0.05),MRA更小(P<0.05),起搏器电池寿命更长(P<0.001),年均治疗费用低(P<0.001);两组患者LVDd、E/APd、LVEF、Ts-SD12及主、肺动脉射血时间差等指标比较,差异均无统计学意义(P>0.05)。结论:双腔起搏器行RA-LV起搏,通过RAAV功能可较好达到心脏再同步化,可改善CHF患者的心功能,节约治疗成本。更多还原

【Abstract】 Objective: To explore the clinical efficacy of rate adaptive atrio-ventricular( RAAV) delay function in right atrial-left ventricular pacing of dual chamber pacemaker in the treatment of congestive heart failure( CHF). Methods: 30 cases of CHF( Ⅲ-Ⅳ grade of NYHA grade) patients with Class Ia indication for cardiac resynchronization therapy( CRT) were selected and randomly divided into right atrium-left ventricular pacing( RA-LV) group and double chamber pacing( Biv) group,15 cases in each group. The patients in RA-LV group were implanted into dual chamber pacemaker with RAAV and the function of biventricular resynchronization was realized by RAAV to track physiological atrial ventricular delay( AVD). The patients in Biv group were implanted into three-chamber pacemaker with biventricular 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),E/A peak period( E/A pd),interventricular mechanical delay( IVMD),duration of QRS complex,battery life and six minutes walk test( 6MWT) were observed before and after pacing therapy in the two groups. Results: Compared with the standard Biv group,the duration of QRS complex was shorter( 134 ± 9) ms vs( 143 ± 10 ms),P < 0. 05) in RA-LV group,and MRA was less( 3. 2 ± 1. 1) cm2 vs( 3.5 ± 1. 3) cm2,P < 0. 05). Furthermore,RA-LV group had significantly longer battery life [( 8. 2 ± 0. 4) yrs vs( 5. 1 ± 0. 3) yrs,P < 0. 001]and had lower average annual cost[( 11600 ± 1200) yuan vs( 21300 ± 2500) yuan,P < 0. 001]. LVDd,E/A pd and LVEF,Ts-SD12 and IVMD had no significant differences between the two groups( P > 0. 05). Conclusion: Right atrial-left ventricular pacing of dual chamber pacemaker can be used to achieve the goal of cardiac resynchronization by RAAV function,which can significantly improve cardiac function in CHF patients and save the treatment cost.更多还原