双心室再同步化起搏治疗慢性充血性心力衰竭临床应用

目的通过对具有心脏再同步化治疗(CRT-P)或心脏再同步化治疗除颤器(CRT-D)植入适应症的患者进行CRT-P或CRTD植入治疗,从而分析研究CRT-P或CRTD对慢性严重充血性心力衰竭或伴致死性心律失常的慢性严重充血性心力衰竭患者的疗效。方法对2005年10月至2009年6月我科收治的慢性严重充血性心力衰竭或伴致死性心律失常的病例22例患者,其中缺血性心肌病12例,扩张性心肌病9例,肥厚性心肌病1例,均按照心力衰竭治疗指南使用最佳药物治疗方案,反复治疗后疗效不佳,符合CRT-P或CRTD植入适应征,植入CRT-P或CRTD。结果所有患者植入手术均获成功。术后随访2～41个月。1例患者术后因全身衰竭死亡。其余患者同时按照心力衰竭治疗指南使用与术前相同的最佳药物治疗心衰,所有患者心功能分级从术前Ⅲ-Ⅳ级改善为术后Ⅰ-Ⅲ级;运动耐量、LVEF(%)较术前明显提高;LVEDD较术前有所减少。结论 CRT-P或CRTD能改善心力衰竭患者的心功能及生活质量等,可以使患者长期获益。CRTD可以通过预防心衰患者恶性心律失常,从而减少死亡率。     

心脏再同步化治疗除颤器在慢性心力衰竭患者中的临床应用

目的总结具有心脏再同步化治疗（CRT）和埋藏式自动复律除颤器（ICD）功能的心脏再同步化治疗除颤器（CRT-D）用于临床治疗慢性心力衰竭（心衰）的初步经验。方法17例药物治疗无效的慢性心衰患者接受了CRT-D治疗,其中6例患者接受了具有心衰预警功能的InSyncSentry。基础病因为扩张性心肌病12例,缺血性心肌病5例;13例患者既往有室性心动过速或心室颤动的发作病史。结果17例患者均成功置入CRT-D,左室导线平均起搏阈值为1．6V,除颤阈值≤20J,无并发症发生。平均随访13个月,5例患者发生室性心动过速诱发的电击除颤。1例置入InSyncSentry的患者由于心功能恶化出现2次心衰报警事件,药物治疗后好转。结论CRT-D置入手术相对安全,不仅能改善患者心功能,而且可预防心脏性猝死的发生。     

慢性充血性心力衰竭心脏再同步化治疗研究进展

心电学异常往往合并心衰共存于心肌病患者中 ,异常的心电顺序使心脏收缩和舒张不协调 ,从而损害心功能。近来短期和长期研究发现应用心脏起搏可使心脏活动再同步、改善心功能、提高生活质量和生存率 ,认为心脏再同步化疗法是严重心衰合并心电学异常患者的一种理想的非药物辅助治疗选择。其潜在的机制包括 :心脏整体活动的再同步化 ,拮抗神经内分泌活性、逆转心脏重塑 ,抗心律失常等。该方法有严格的适应证 ,可根据患者情况选择不同的方法。文章综述了心脏失同步化的病理生理及心脏再同步化治疗相关临床试验、显效机制、技术关键及存在的问题     

心室再同步心脏复律除颤器治疗慢性心力衰竭合并恶性心律失常1例

慢性心力衰竭（chronicheartfailure,CHF）是大多数心血管病的最终归宿,也是最主要的死亡原因。根据我国2003年的抽样统计成人心衰患病率为0．9％。年死亡率可达5％～10％。约62％的心衰患者有左右心室间不同步。心室再同步治疗（CRT）已被证明可有效改善CHF伴有心脏收缩不同步患者的心功能,在合理药物治疗的基础上使总死亡率下降了36％,联合心脏复律除颤器（ICD）即心室再同步心脏复律除颤器（CRT—D）降低死亡率可达43%.     

心脏再同步治疗除颤器治疗慢性心力衰竭的临床应用体会

目的:初步总结应用心脏再同步化治疗除颤器(CRT-D)治疗慢性心力衰竭(CHF)合并恶性室性心律失常的临床体会。方法:选取的6例CHF患者均为心功能Ⅲ～Ⅳ级(NYHA分级),且有恶性室性心律失常发作史,体表心电图QRS波0.12s,术前组织多普勒超声检查均提示存在心脏收缩不同步,药物治疗无效。置入CRT-D。随访观察患者临床症状、心功能、左室射血分数(LVEF)变化及室性心律失常的发生情况。结果:CRT-D置入术中右心房、左心室起搏电极感知和起搏参数均符合要求,右心室除颤电极的感知、起搏及除颤阈值良好。起搏前QRS时限平均189ms,起搏后平均142ms。随访6～36个月,心功能较术前明显改善,LVEF术前平均0.33,术后6个月平均0.47。6例患者随访期间共发生室性心动过速2次,CRT-D均以31～34J的能量1次除颤成功。结论:CRT-D不仅可有效改善CHF患者的临床症状,增加LVEF,改善心功能。同时可有效治疗室性心动过速等恶性室性心律失常,预防心脏性猝死。     

充血性心力衰竭伴室性心律失常临床分析

充血性心力衰竭 (CHF)伴室性心律失常 (VA)极为常见 ,且可能是尔后出现严重甚至致死性 VA的前兆 ,CHF患者的 VA多与猝死密切相关 ,且常无明显症状 ,故有重要临床意义。作者对其发生率、发生机制、临床特点及其对预后的影响进行分析。1　临床资料　　 CHF患者 16 5例均为住院病例 ,其中伴 VA者 12 0例 ,男 79例 ,女 41例 ,年龄 2 4～ 73岁 ,平均 5 9.3岁。基本病因为冠心病 6 4例 ,扩张型心肌病 16例 ,高血压性心脏病 15例 ,风湿性心脏病 16例 ,糖尿病心肌病 4例 ,围产期心肌病 2例 ,病毒性心肌炎 3例。所有病例均根据病史 ,体检、X…     

充血性心力衰竭伴心室颤动植入InSync心律转复除颤器治疗一例

患者男性 ,70岁。因心前区疼痛 10年 ,心慌气短 1年 ,加重 1ｄ于 2 0 0 2年 7月 30日入我院心内科。患者 10年前出现心前区疼痛 ,劳累后加重 ,1998年患急性前壁心肌梗死 ,1999年 10月行冠状动脉造影示 3支血管病变 ,行冠状动脉旁路移植术。 2 0 0 1年患者再次出现胸痛 ,造影复查示前降支桥血管开口处狭窄 70 % ,对桥病变植入支架 1枚。近 1年来经常出现心慌气短、不能平卧 ,长期用强心、利尿、血管扩张剂等药物治疗 ,疗效不显著 ,症状反复发作。入院前 1ｄ突然心慌气短加重伴咳嗽 ,不能平卧 ,尿少。本次入院体格检查示血压 12 0 /70ｍｍＨｇ…     

心脏再同步化治疗慢性心力衰竭的临床疗效

目的观察心脏再同步化治疗对慢性心力衰竭患者改善心功能和逆转左心室重构的作用。方法11例慢性心力衰竭患者接受心脏再同步化治疗,心功能NYHA分级Ⅲ～Ⅳ级,左室射血分数≤35%,伴QRS波时限≥130ms。随访1～36个月,观察和分析术前、术后相关参数的基准水平及参数基准水平的变量。结果心脏再同步化治疗后1～36个月,左心室射血分数、左心室短轴缩短率增加,左心室舒张末内径、二尖瓣返流、QRS波时限减少,NYHA分级提高到Ⅰ～Ⅱ级,6min步行距离明显增加。结论对于心功能NYHA分级Ⅲ级或Ⅳ级伴有室内传导阻滞的心力衰竭患者,心脏再同步化治疗能逆转左心室重构,改善心功能。     

双心室同步房室顺序起搏植入型心律转复除颤器

目的 观察双心室同步房室顺序起搏植入型心律转复除颤器(ICD)对扩张性或缺血性心肌病出现顽固性充血性心力衰竭同时伴有恶性室性心律失常时的治疗效果。方法 5例患者均为男性。心功能(NYHA分级)Ⅲ～Ⅳ级。QRS时限120～183ms，左心室射血分数(LVEF)≤0．30，左心室舒张末直径≥60mm，均有室性心动过速(室速)及心室颤动(室颤)发作史。药物治疗无效。分别植入右心房和心脏静脉左心室分支起搏电极导线，并植入右心室除颤电极导线，行房室顺序双心室同步起搏及抗室性心律失常治疗。随访观察患者临床症状、心功能、LVEF及室性心律失常的变化。结果 右心房、右心室和左心室导线感知和起搏参数均符合要求、右心室导线除颤阈值佳。起搏后QRS时限明显缩短，起搏前平均155ms，起搏后平均133ms，随访3～20个月，心功能术前平均3．4级，术后3个月平均2．4级；LVEF术前平均0．25，术后3个月0．29，1例术后6个月LVEF为0．34；5例患者共发生室速4次，均以31J的能量1次除颤成功。结论 双心室同步房室顺序起搏可改善心力衰竭患者的临床症状，增加LVEF，改善心功能。双心室同步起搏ICD具有良好的抗室性心律失常的功能。     

心力衰竭患者心脏再同步化治疗最新进展

心力衰竭指心脏结构或功能性原因导致心室充盈和/或射血功能受损而引起的一组综合征。心脏再同步化治疗(CRT)是心力衰竭中的一种器械治疗方式,旨在通过双心室起搏改善心室收缩的不同步,进而提高射血分数,改善心功能。自20世纪90年代开始CRT应用于临床,大量临床研究证实了其安全性及有效性,其适应证在不断扩大,但CRT与心脏再同步化治疗除颤器的选择在临床上一直存在疑问,且近几年希氏束-浦肯野系统起搏开始应用于CRT中,使这一领域出现新的憧憬。现就目前CRT的研究现状,其与心脏再同步化治疗除颤器和希氏束-浦肯野系统起搏的抉择进行综述,给临床工作提出一定的指导意义。     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.     

慢性心力衰竭患者心脏再同步治疗疗效观察

目的随访慢性心力衰竭患者心脏再同步治疗（CRT）的临床疗效。方法入选1999年至2008年行CRT的慢性心力衰竭患者,收集这些患者基线和最后一次临床资料。采集数据包括临床心功能评估,心脏超声学指标和体表心电图QRS时限宽度。结果95例患者行CRT治疗,分为早期组和近期组。早期组随访时间（57±17）个月,随访生存率为66．6％;近期组随访时间（18±10）个月,生存率为89．1％。两组患者CRT治疗后心功能显著提高,但自身状态下体表心电图QRS时限宽度变化差异无统计学意义。随访中患者药物治疗变化明显。结论中长期和短期随访均证实CRT治疗在一部分慢性心力衰竭患者中能提高心功能,但缺乏预测疗效的敏感指标。     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.