双腔起搏器不同房室间期起搏对心功能影响的研究

探讨双腔起搏器不同房室间期 (AVD)起搏对即时心功能的影响 ,并观察根据即时心功能调定的最佳房室间期对CHF患者长期疗效的影响。用M型和B型超声心动图比较了 6例无心力衰竭DDD起搏者和 14例CHFDDD起搏患者 (其中 13例存在缓慢型心律失常 )不同AVD起搏时心功能参数的变化。 14例CHFDDD起搏患者常规起搏 3个月后随机分为常规起搏组 (7组 )和最佳房室间期起搏组 (7例 ) ,起搏 3个月后随访心功能 (NYHA分级 )和心室腔径的改变。结果 :CHF组和无心力衰竭组不同AVD起搏时各项心功能指标变化均无差异 (P >0 .0 5 ) ;常规起搏组和最佳AVD起搏组起搏 3个月后NYHA分级和心室腔径无显著变化 (P >0 .0 5 )。结论 :经调定的短AVDDDD起搏不能改善CHF患者的心功能和心室重构。不宜将双腔起搏器最佳AVD起搏作为CHF患者的常规非药物疗法 ,对因纠治心脏电学异常而安装DDD起搏器的CHF患者 ,在无其他证据之前仍宜采用常规AVD起搏

The Acute and Long-ter m Effects of Different Atrioventricular Delays of DDD Pacing Mode on Cardiac Fun ction in Patients with Congestive Heart Failure

This prospective study assessed the acute effects of different AV delays (AVD) during DDD pacing and long term clinical benefits of dual chamber pacing with a optimized AVD according to the acute effects on cardiac function in patients with CHF.The parameters of cardiac function (left ventricular volume in end diastolic phase,left ventricular volume in systolic phase,SV,fractional shortening,EF,SI,CO,CI) were measured by M mode and B mode echocardiography in 20 patients (6 patients without CHF,14 patients with CHF) with DDD pacing at different AVD.The best AVD was defined as the delay resulting in the highest SV.Then we undertook a prospective,double blind,randomized,controlled by 2 D echocardiography in 4 chamber view were recorded in baseline and 3 month follow up.Results:(1)There was no significant difference in acute cardiac function among various AVDs studied( P>0.05 ).(2)There was no significant improvement between two pacing groups( Z=1.3628,P=0.1730 ).Conclusions:Pacing with the best AVD can not improve cardiac function or ventricular remodeling.Routine use of pacemaker therapy with a select optimal AVD as a primary non pharmacologic treatment of CHF is unwarranted.The AV delay still should be set at routine value if the patient need to be implanted a dual chamber pacemaker to treat the electrical abnormalities of the failing heart.