双心室再同步治疗充血性心力衰竭的临床研究

目的　探讨双心室再同步治疗充血性心力衰竭的疗效。方法　所选择患者均为心功能Ⅲ～Ⅳ级 ,左心室舒张末期内径 >60mm ,EF值 <3 5 % ,E、A峰融合 ,二尖瓣中等度以上返流 ,完全性左束支传导阻滞 ,QRS时限 >14 0ms。应用Insync 80 40三腔起搏器 ,起搏电极定位于右心耳、右心室心尖部、冠状静脉窦左侧支或侧后分支。术后以VAT方式起搏。结果　例 1随诊 6个月 ,例 2随诊 1个月 ,2例术后心功能均提高至Ⅱ级 ,EF值明显提高 (例 1,2 1%VS3 0 % ;例 2 ,2 7%VS 3 8% ) ,QRS波时限明显缩短 (例 1,2 0 0msVS 110ms ;例 2 ,180ms ;例 2 ,VS 13 0ms) ,术后经心脏超声优化A—V间期 ,90ms时E、A峰分离程度最大 ,二尖瓣返流明显减少。例 1,术后 6个月左心房及左心室舒张末期内径无明显缩小。例 2 ,术后 1个月左心房 ( 4 3mmVS 3 5mm)及左心室舒张末期内径 ( 92mmVS 85mm)缩小明显。结论　双心室再同步治疗充血性心力衰竭近期疗效满意 ,是值得深入研究的新方法。

Effect of ventricular resynchronization therapy on congestive heart failure

Objective To explore the effects of ventricular resynchronization therapy on congestive heart failure.Methods The tow patients with severe dilated cardiomyopathy and intraventricular conduct delay (NYHA class Ⅲ to IV,left bundle branch block,QRS>140 miliseconds, Ejection fraction<35%,left ventricular end-diastolic volume>60 mm) received biventricular pacemaker(Medtronic 8040), and 2178 or 4189 Coronary vein lead was inserted into the branch of coronary sinus to pace left ventricle. The two patients had been studied by ECG and echocardiography. Results After bioventricular pacing,there was significant improvement of ejection fraction and NYHA class from Ⅲ～Ⅳ to Ⅱ grade,decrease in mitral regurgitation , QRS wave complex duration,and left ventricular end-diastolic volume.Conclusion The ventricular resynchronization therapy appears to improve the functional status of patients with dilated cardiomyopathy and left bundle branch block.