右室双部位起搏治疗心力衰竭的临床观察

评价 15例患者经右室双部位起搏治疗慢性心力衰竭 (简称心衰 )的疗效。其中原发性扩张型心肌病心衰 13例、缺血性心肌病心衰 2例 ;心功能Ⅲ级 9例、Ⅳ级 6例。结果 :15例患者安置时右室心尖部起搏阈值 0 .5± 0 .3(0 .3～ 1.0 )V、R波振幅 15± 5 .98(6～ 2 4.6 )mV ,阻抗 6 13± 172 (32 0～ 90 0 )Ω。右室流出道起搏阈值 0 .7± 0 .2 6 (0 .3～1.3)V、R波振幅 13± 5 .5 5 (6 .5～ 2 3.6 )mV、阻抗 5 6 3± 194(30 0～ 90 0 )Ω ;双部位起搏阈值 1.45± 0 .45 (0 .9～ 1.7)V。双部位起搏心电图QRS波群时限比右室心尖部及右室流出道单部位起搏缩短了 40～ 90ms。超声心动图检查提示双部位起搏后二尖瓣返流面积平均减少 5 .6cm2 ,射血分数值提高 5 .2 %。经 6 .0± 1.5个月的随访 ,15例中除 2例因突发恶性室性心律失常猝死外 ,其余患者的心功能分别从Ⅲ、Ⅳ级改善到Ⅱ和Ⅲ级。右室双部位慢性起搏阈值1.85± 0 .5 6 (1.5～ 2 .5 )V。随访期间QRS波群时限平均下降 5 0ms。结论 :右室双部位起搏能有效的治疗心肌病患者的心衰。

The Clinical Observation of the Effects of the Dual Sites Pacing in the Right Ventricular on Chronic Congestive Heart Failure

The aim of this study is to evaluate the therapeutic efficacy of dual sites right ventricular pacing in 15 patients with dilated cardiomyopathy.Basic heart disease:13 cases had dilated cardiomyopathy with chronic congestive heart failure(CHF),2 patients had coronary heart disease with CHF;Among these six patients with New York Heart Association(NYHA) cardiac functional class Ⅲ,9 cases with NYHA class Ⅳ.Results:The pacing threshold of the right ventricular apex was 0.5±0.3(0.3～1.0) V,the amplitude was 15±5.98(6～24.6) mV,the resistance was 613±172(320～900) Ω.Whereas,the threshold of the right ventricular outflow tract was 0.7±0.26(0.3～1.3) V,the amplitude was 13±5.55(6.5～23.6) mV,the resistance was 563±194(300～900) Ω;However,the threshold of dual sites was 1.45±0.45(0.9～1.7) V.The QRS duration in dual sites pacing decreased for 40～90 ms compared with that of single site pacing.The degree of the mitral regurgitation decreased markedly after the dual sites pacing,the mean area of the mitral regurgitation decreased for 5.6 cm 2,the ejection fraction increased for 5.2 %.After 6.0±1.5 months follow up (except for 2 cases died of sudden death),the cardiac function improved from NYHA class Ⅲ and Ⅳ to class Ⅱand Ⅲ,the threshold of dual sites pacing was 1.85±0.56(1.5～2.5) V.The QRS complex duration decreased for 50 ms.Conclusion:These results showed that the dual sites pacing in the right ventricular may be beneficial to the heart failure of dilated cardiomyopathy.