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两例全心扩大、左心功能不全伴房室传导阻滞患者,植入双腔起搏器(DDD)后完全依赖右室起搏,分别在植入起搏器后3年和5年左心功能恶化,症状逐渐加重,成功升级为心脏再同步化治疗除颤器(CRT-D)。术后3个月随访,两例心功能均由术前Ⅲ～Ⅳ级(NY-HA分级)提高到Ⅱ级,例1左室舒张末期内径(LVDd)由75mm缩小为68mm,左室收缩末期内径(LVDs)由64mm缩小为60mm,左室射血分数(LVEF)由0.20提高至0.33;例2LVDd由60mm缩小为50mm,LVDs由52mm缩小为37mm,LVEF由0.32提高至0.45,但未记录到恶性室性心律失常和电除颤事件。结论 :完全依赖右室起搏恶化有全心扩大基础的左心功能不全,升级为CRT-D后3个月明显改善心功能并使左室缩小。
Two cases of heart enlargement, left ventricular dysfunction with atrioventricular block, implantation of dual chamber pacemaker (DDD) completely dependent on right ventricular pacing, respectively, 3 and 5 years after implantation of pacemaker left The heart function deteriorated, the symptoms gradually aggravated, and successfully upgraded to cardiac resynchronization therapy defibrillator (CRT-D). After 3 months of follow-up, the cardiac function of both cases was improved to grade Ⅱ from NYHA grade before operation. In case 1, the left ventricular end-diastolic diameter (LVDd) decreased from 75mm to 68mm, and the left ventricular end- The LVDs decreased from 64mm to 60mm and the LVEF increased from 0.20 to 0.33. The LVDs decreased from 60mm to 50mm, the LVDs decreased from 52mm to 37mm, and the LVEF increased from 0.32 to 0.45, Malignant ventricular arrhythmias and defibrillation events. CONCLUSION: Complete reliance on right ventricular pacing worsens left ventricular dysfunction with heart-centered expansion, improving cardiac function 3 months after CRT-D upgrade and left ventricular contraction.