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目的 观察心室同步起搏对顽固性伴有室内传导或室间隔运动异常的充血性心衰的治疗效果。方法 选择 2 1例 ,其中男 18例 ,女 3例 ,年龄 ( 64± 11)岁 ,合并左束支阻滞的顽固性心衰患者给予双心室同步起搏治疗 ( 16例安装三腔起搏器 ,5例安装三腔心脏自动交律除颤器 )。观察术中、术后 3、6月左室电极的起搏参数 ,同时观察术前、术后 3个月的QRS波时限、LVEF、LVDD、二尖瓣返流量、VO2 max以及临床症状的变化。结果 随访 3～ 2 0个月 ,左室电极的起搏阀值、阻抗及感知各参数值稳定 (P >0 .0 5 ) ,起搏功能良好。与术前相比 ,术后 3个月LVEF等心功能指标均明显改善 (P <0 .0 5 )。随访期间猝死 1例 ,接受心脏移植 1例。结论 心室再同步治疗是治疗存在室间传导异常的充血性心衰的有效的新方法。三腔起搏器可改善患者血流动力学、心功能和心衰的临床症状。左室电极的植入成功率高 ,性能稳定 ,安全可靠。三腔ICD不仅可治疗心衰 ,同时具有良好的抗室性心律失常预防猝死的作用
Objective To observe the therapeutic effect of ventricular synchronized pacing on refractory congestive heart failure with conduction or ventricular septal dysfunction. Methods Twenty-one patients were selected, including 18 males and 3 females, aged 64 ± 11 years. Patients with refractory heart failure with left bundle branch block were treated with biventricular pacing (16 patients with three-chamber pacing Device, 5 cases installed three-chamber cardiac automatic defibrillator). The intraoperative and postoperative parameters of left ventricular pacing in 3 and 6 months postoperatively were observed. The changes of QRS wave duration, LVEF, LVDD, mitral regurgitation, VO2 max and clinical symptoms were observed before and 3 months after operation . Results The follow-up of 3 to 20 months showed that the values of pacing threshold, impedance and sensory parameters of left ventricular electrode were stable (P> 0.05) and pacing function was good. Compared with preoperative, 3 months after LVEF and other cardiac function indicators were significantly improved (P <0. 05). 1 case of sudden death during follow-up and 1 case of heart transplantation. Conclusions Ventricular resynchronization therapy is a new and effective method for the treatment of congestive heart failure with abnormalities of interventricular conduction. Three-chamber pacemakers improve clinical symptoms in patients with hemodynamics, cardiac function, and heart failure. Left ventricular electrode implantation success rate, stable performance, safe and reliable. Three-chamber ICD not only treats heart failure, but also has a good anti-arrhythmic effect of preventing sudden death