双心室起搏逆转心脏结构重塑的临床观察

观察双心室同步起搏治疗慢性充血性心力衰竭 (简称心衰 )逆转心脏结构重塑的中远期疗效并探讨其可能机制。4例扩张性心肌病中晚期患者 ,心功能NYHA分级Ⅲ级 2例、Ⅳ级 2例 ,均伴有心室内阻滞。其中 3例置入三腔双心室起搏器、1例为四腔起搏。术后对心功能、二维超声心动图、动态心电图、心脏远达正侧位片等进行了 12～ 2 0个月的随访。所有双心室起搏器均一次性安置成功。随访资料显示 4例患者各房室内径 ,心胸比率缩小 ;心脏搏出量、左室射血分数等显著提高 ;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。心脏结构重塑时间发生在术后 6个月内 ,以后结构趋于稳定。 4例中 1例猝死 ,无一例因严重心衰而住院或死亡。结论 :双心室起搏能逆转慢性心衰患者的心脏结构重塑 ,明显改善心功能 ,提高生活质量。

The Clinical Study of Biventricular Pacing Reversing Cardiac Remodeling in Heart Failure.

To observe the effect of reverse cardiac structure remodeling in patients with chronic congestive heart failure(CHF) by biventricular pacing and its underlying mechanisms,four patients with NYHA class Ⅲ to Ⅳ heart failure,left ventricle ejection fraction(LVEF)≤0.35,and electrocardiographic QRS wave complex duration>140 ms were recruited.All patients received biventricular pacing(3 case in right atrial and biventricular pacing and 1 case in biatrial and biventricular pacing)and the effects of this therapy were assessed serially up to 12～20 months after pacing by 2D UCG,Holter,NYHA class and 6 minute hall walk distance etc.Compared with the corresponding values at baseline,there was significant improvement of LVEF,cardiac output,and 6 minute hall walk distance and decreasing in the diameter of atria and ventricle after pacing for 12～20 months.The reducing in mitral regurgitation,QRS duration and NYHA class were also observed.Conclusion:Biventricular pacing reverses heart structure remodeling and improves cardiac function in patients with CHF.