左室和双心室起搏对心肌病晚期心衰患者的血流动力学研究

目的　对心电图呈左束支阻滞的晚期心肌病患者行左室和双心室起搏 ,了解左室和双心室起搏的急性期血流动力学效应。方法　对 16例心电图呈左束支阻滞的晚期心肌病患者行左室游离壁和双心室起搏 ,记录左室、双心室和基础状态下的左室腔内dP/dtmax、主动脉根部压力和心电图QRS波宽度。结果　左室和双心室起搏分别使左室dP/dtmax提高 2 1%和 18% (P <0 0 1) ,而左室和双心室起搏组无显著差异 (P >0 0 5 ) ;左室起搏和双心室起搏使主动脉收缩压较基础状态升高 6 %和 5 % (P <0 0 1) ,左室和双心室起搏组间差异不显著 (P >0 0 5 ) ;左室起搏心电图QRS间期缩短不明显 (P >0 0 5 ) ,而双心室起搏QRS间期明显缩短(P <0 0 5 )。结论　对于心电图呈LBBB型的心肌病终末期心衰患者 ,行双心室起搏和左室游离壁起搏均使患者的急性期血流动力学得到显著改善 ,两者的效果相当

Comparing hemodynamic response between left ventricular and biventricular pacing in cardiomyopathy patients with end stage heart failure

Objectives Hemodynamic assessment left-and bi-ventricular pacing in cardiomyopathy patients with end-stage heart failure. Methods Sixteen cardiomyopathy patients with LBBB were studied. Left ventricular dP/dtmax, aortic root pressure and QRS duration were measured under the condition of left free-wall pacing, biventricular pacing and baseline. Results Comparing with baseline, left ventricualr pacing improved dP/dtmax by 21% and systolic pressure by 6%(P<0.01);biventricular pacing raised LV dP/dtmax by 18% and systolic pressure by 5%(P<0.01). No significant difference was observed between left-and bi-ventricular pacing groups(P>0.05). Mechanical improvement with biventricular pacing was associated QRS narrowing(P<0.05),but in left ventricular pacing group, QRS duration showed no changes(P>0.05). Conclusions The two pacing modes (left-and bi-ventricular) were associated with almost equivalent hemodynamic improvement in terms of LV dP/dtmax and aortic root systolic pressure.