心脏起搏的某些进展

心脏起搏的某些进展成都核工业４１６医院陈厚骧综述成都市第三人民医院刘运德审校成都市心血管病研究所心脏起搏治疗缓慢性心律失常已获广泛应用，欧美国家每年新安置起搏器（ＰＭ）约４００台／百万人口，其中７０％为生理性起搏，国内每年安置ＰＭ约２０００台，生理性...     

心脏不同部位起搏的临床研究进展

永久性心脏起搏已成为症状性心动过缓、充血性心力衰竭等患者的有效治疗方法,基于最大程度恢复心脏正常激动和传导顺序的原则,生理性起搏成为近年来心脏起搏研究的热点。关于起搏部位的研究也有很多新的进展,现综合近年来心脏起搏部位临床研究的结果,对心脏不同部位起搏的临床进展作一综述。     

多部位心脏起搏

随着起搏技术的快速发展，其适应证也有了扩展，并非仅限于心动过缓。近年临床应用的多部位心脏起搏由于它具有恢复心房或心室电机械同步的作用，因而可用于治疗房性快速心律失常、扩张型心肌病（ＤＣＭ）、梗阻性肥厚型心肌病、充血性心力衰竭等难治性心脏疾病。１理论基...     

无创性心脏起搏抢救心脏骤停20例

紧急心脏临时起搏是抢救心脏骤停的重要措施。我院自 2 0 0 1年 1月至 2 0 0 3年 6月采用无创性心脏起搏抢救 2 0例心脏骤停的患者 ,取得了较好的疗效 ,报告如下。资料与方法一般资料　 2 0例患者中男 13例 ,女 7例。年龄 2 8～ 72岁 ,平均 4 7.6岁。原发疾病包括 :急性心肌梗死 9例 ,病态窦房结综合征 7例 ,病毒性心肌炎4例。起搏前心电图表现心室停搏 11例 ,电 机械分离 9例。仪器设备　使用美国LIFEPAK 2 0心脏起搏除颤仪及QUIK COMBO大面积皮肤电极。操作方法　酒精擦拭局部皮肤 ,阳极电极置于背部左侧肩胛骨与脊柱之间心脏水平…     

起博脉冲引导的临时心脏起搏

目的：探讨用起博脉冲引导的临时心脏起博的可行性。方法：应用深静脉穿刺和带漂浮球囊的起博电极,经体表心电图在起博脉冲的指导下定位,进行床旁临时心脏起博。结果：86例起博均获成功,且无严重的室性心律失常。结论：床旁经静脉临时心脏起博在体表心电图监测下,用起博脉冲定位是安全有效的。     

心脏再同步化起搏治疗心力衰竭

几十年来,随着血管紧张素转化酶抑制剂或血管紧张素拮抗剂、醛固酮拮抗剂、β受体阻滞剂的推广应用,心力衰竭(CHF)的治疗取得了巨大的进展。     

Transcutaneous cardiac pacing in the treatment of out-of-hospital pediatric cardiac arrests.

STUDY OBJECTIVE: To evaluate the effectiveness of transcutaneous cardiac pacing in out-of-hospital treatment of cardiac arrests in pediatric patients. DESIGN: We describe the outcome of patients treated during a prospective trial of transcutaneous cardiac pacing in the field. We compare their outcome with that of out-of-hospital arrests in submersion patients who were not paced. We identified patients from Seattle and King County Emergency Medical Services reports, hospitals, and medical examiner's registries. MEASUREMENTS AND MAIN RESULTS: Nine patients in cardiac arrest caused by drowning (six) and sudden infant death syndrome (three) were paced in the field. All were less than 6 years old. The one survivor was severely neurologically impaired and died six months later. Transcutaneous cardiac pacing produced electrical capture in two patients but no detectable pulse or blood pressure. Ten submersion patients less than 6 years old in cardiac arrest were not paced. One survived, with mild neurologic impairment at hospital discharge. CONCLUSION: Transcutaneous cardiac pacing was not effective and was not associated with improved survival.     

Biventricular cardiac pacing

Chronic heart failure (CHF) is a very frequent condition. Its frequency increases with prolongation of median life expectancy and due to improvements in medical care. However, medical treatment does not allow adequate control of symptoms in many cases. Therefore, various nonpharmacological approaches are being developed. The so-called biventricular pacing is one of them. Its main goal is to restore impaired mechanical cardiac synchrony that is present in patients with prolonged QRS duration due to inter- or intraventricular conduction abnormality. At present, biventricular pacing can be achieved through positioning of a special pacing lead into a branch of the coronary sinus on the surface of the left ventricle and implanting the other lead into the right ventricular cavity, and the third lead into right atrial appendage. Clinical trials and experience from many centres have documented improvements in clinical status in the vast majority of patients. An improvement in functional classification (NYHA) by at least one class, prolongation of the six minute walk distance by 20-40%, increase the maximal oxygen uptake by 10-40% a beneficial effect on quality of life can be expected. Preliminary results of the COMPANION trial have suggested that cardiac resynchronization therapy is associated with prognostic effect, especially in conjunction with implantable cardioverter-defibrillator.     

Rate-responsive cardiac pacing

The term "synchronous pacemaker (SPM)" is used to describe all pacemakers of which the frequency can be accelerated by means of a sensor other than the sinus node. The most commonly used system is the detection of changes in physical activity by means of a quartz crystal included in the casing. Changes in respiratory volume, the respiratory rate, the QT interval or central temperature have been less successfully used. Single and double-chamber (DC) synchronous pacemakers exist. Ventricular single-chamber synchronous pacemakers (VVIR) are primarily intended for active patients in a state of chronic atrial fibrillation or, secondarily, in cases in which the insertion of an atrial electrode raises difficulties. The single-chamber atrial synchronous pacemaker (AAIR), or preferably the double-chamber equivalent (DDDR) is intended for the correction of chronotropic failure, whether this is primary or induced by bradycardiac antiarrhythmic medication. AVB should be treated by double-chamber simulation designed to pick up P waves. The value of the synchronous pacemaker in these patients is that it makes it possible to partially offset the loss of atrial systole in cases of ventricular fibrillation by a synchronous pacemaker (pacemaker programmed to shift from DDD to VVIR). The setting of the SPM is fairly complex and calls for exercise tests. Iatrogenic acceleration is not unusual and must be identified by long-term recordings. All these pacemakers will here include a "synchronous" option, which may be of variable efficacy. It is up to the clinician to use them appropriately, and not automatically, remembering that the best sensor is the sinus node and that synchronous pacemakers are only second best.