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目的:观察双心室同步起搏治疗对药物难治性充血性心力衰竭的治疗效果。方法:20例慢性心力衰竭患者,心功能(NYHA分级)Ⅲ～Ⅳ级,QRS时限≥120ms,左室射血分数(LVEF)≤35%,左室舒张末期内径(LVEDD)≥55mm,伴二尖瓣反流。经多种抗心力衰竭药物治疗无效后行双心室同步起搏治疗,其中1例安装三腔埋藏式心脏复律除颤器(ICD)。术后随访观察临床症状并进行心脏彩超检查,平均随访3～60(24±12)个月。结果:手术顺利,无并发症,术后心功能平均改善Ⅰ～Ⅱ级,射血分数、左室内径、左室质量指数、二尖瓣反流及心胸比例均较术前有明显改善(均P<0.05);死亡3例,因心室颤动猝死1例,非心源性死亡2例。结论:双心室再同步化起搏治疗可以明显改善患者心功能,提高生活质量,逆转左室重构,且随着时间延长持续改善。
Objective: To observe the therapeutic effect of biventricular pacing in patients with refractory congestive heart failure. Methods: Twenty patients with chronic heart failure were divided into three groups: NYHA class Ⅲ ~ Ⅳ, QRS ≥120 ms, left ventricular ejection fraction ≤35%, left ventricular end-diastolic dimension (LVEDD) ≥55 mm, Cricoid regurgitation. After a variety of anti-heart failure drug treatment failed to perform biventricular synchronized pacing therapy, including 1 case of three-chamber implantable cardioverter-defibrillator (ICD). All patients were followed up for clinical symptoms and echocardiography. The patients were followed up for an average of 3 to 60 (24 ± 12) months. Results: The operation was smooth and no complications were found. The average improvement of cardiac function in grade Ⅰ ~ Ⅱ after operation was found. The ejection fraction, left ventricular diameter, left ventricular mass index, mitral regurgitation and cardiothoracic ratio were significantly improved P <0.05). There were 3 deaths, 1 sudden death due to ventricular fibrillation and 2 noncardiac deaths. Conclusion: Biventricular resynchronization pacing therapy can significantly improve cardiac function, improve quality of life, reverse left ventricular remodeling, and continue to improve over time.