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观察右房 左室起搏治疗慢性心力衰竭 (简称心衰 )的临床效果。选择 1 6例充血性心衰患者 (NYHA分级Ⅲ Ⅳ级 ) ,男 1 0例、女 6例 ,年龄 6 8.4± 6岁 ;均为窦性心律 ,合并有Ⅰ度房室阻滞 ,完全性左束支阻滞。按安置起搏器的模式分为右房 左室起搏治疗组 (LV组 ,n =6 ) ,右房双室起搏治疗组 (BiV组 ,n =1 0 )。左室起搏电极分别放置于心大静脉左室侧后分支 9例 ,心大静脉左室后分支 7例。观察起搏治疗前后左室心功能参数、6min步行距离、左室壁运动的同步性及体表心电图的变化。结果 :BiV组左室射血分数 (LVEF)由术前的 0 .2 3提高至 0 .31 (P <0 .0 0 1 ) ;在LV组LVEF由术前的 0 .2 4提高至 0 .33(P <0 .0 0 1 ) ;左室舒张末期容积指数在二组分别由术前的 1 4 9± 5 1ml/m2 和 1 5 3±5 3ml/m2 下降至 1 1 6± 38ml/m2 和 1 2 1± 4 1ml/m2 (P均 <0 .0 0 1 ) ;室间隔与左室后壁运动的延迟时间在二组分别由术前的 1 95± 94ms和 1 97± 89ms下降至 1 7± 6 0ms及 1 6± 5 6ms(P均 <0 .0 0 1 )。 6min步行距离则分别由术前的4 0 3± 5 3m和 4 0 1± 5 9m提高至 4 4 1± 6 2m和 4 4 2± 6 7m(P均 <0 .0 5 )。结论 :初步临床观察提示右房 左室起搏治疗与右房双室起搏治疗相比 ,同样可有效地改善慢性心衰?
To observe the clinical effect of right atrial pacing in patients with chronic heart failure (referred to as heart failure). Sixteen patients with congestive heart failure (NYHA class Ⅲ Ⅳ) were enrolled in this study. There were 10 males and 6 females with a mean age of 6 8.4 ± 6 years. All of them were sinus rhythms with grade Ⅰ AV block. Completeness Left bundle branch block. According to the mode of placement of pacemaker, they were divided into right atrial pacing group (LV group, n = 6) and right atrial biventricular pacing group (BiV group, n = 10). Left ventricular pacing electrodes were placed in the ventricular left ventricular cardiac ventricular in 9 cases, cardiac ventricular left ventricular after the branch in 7 cases. The changes of left ventricular cardiac function parameters, walking distance at 6 minutes, left ventricular wall motion and surface electrocardiogram were observed before and after pacing therapy. Results: The left ventricular ejection fraction (LVEF) in BiV group increased from 0.23 to 0.31 (P <0.01) in preoperative group. The LVEF in LV group increased from 0.24 before operation to 0 .33 (P <0.001). The left ventricular end-diastolic volume index decreased from 119 ± 5 1ml / m2 and 153 ± 53ml / m2 in the two groups to 116 ± 38ml / m2 and 1 2 1 ± 4 1ml / m2 (P <0.01). The delay of ventricular septum and left ventricular posterior wall motion was significantly different between the two groups by preoperative 195 ± 94ms and 1 97 ± 89ms Decreased to 17 ± 6 0ms and 16 ± 56ms (P <0.01). 6min walk distance from the preoperative 4 0 3 ± 5 3m and 4 0 1 ± 5 9m increased to 4 4 1 ± 6 2m and 442 ± 6 7m (P all <0.05). Conclusions: Preliminary clinical observations suggest that right atrial pacing in left ventricular versus pacing in right atrium may also be effective in improving chronic heart failure.