生理性双腔起搏时最佳AV间期选择与心功能关系的探讨

对 2 0例心肌病心力衰竭 (简称心衰 )患者 (心衰组 )及 10例心功能正常者 (对照组 )行双腔 (DDD)起搏治疗 ,探讨不同AV间期DDD起搏对心衰患者的急性血液动力学效应。经锁骨下静脉置入双腔起搏电极 ,并同时置入Swan Ganz导管 ,测量不同AV间期的急性血液动力学效应 ,二维超声多普勒测量超声形态学指标。结果 :急性起搏时心衰组AV间期在 10 0～ 140ms时 ,血液动力学较起搏前显著改善 ,而以AV为 111± 15ms为最佳。左室舒张末径、左室收缩末径、左房内径显著缩小 ,收缩期二尖瓣返流减轻 ,未发现舒张期二尖瓣返流。而对照组AV间期为16 0～ 180ms时 ,上述指标与起搏前相比显著改善。结论 :短AV间期的生理性起搏能即刻改善心衰患者的急性血液动力学效应和超声形态学指标。

The Study of the Relation Between the Optimal AV Interval and Cardiac Function in Patients Treated With Physiological Dual-Chamber Pacing

To study the relation between the optimal AV interval and cardiac function in patients treated with physiological dual chamber pacing,an acute hemodynamic effect of dual chamber pacing (DDD) at varying AV intervals in 20 patients with heart failure and 10 control subjects was determined.The electrode lead of DDD was positioned visubclavian vein,a Swan Ganz catheter and a 2 dimension doppler echocardiography were performed to measure an acute hemodynamic echocardiography parameters in varied AV intervals.Results:hemodynamic effect was significantly improved from an AV interval setting of 100 msec to 140 msec in acute pacing compared with those before pacing in all patients,especially in 111±15 msec of AV interval,end diastolic dimension of left ventricular,end systolic dimension of left ventricular and left atrial regurgitation was reduced and diastolic mitral regurgitation was abolished.The above mentioned parameters were also significantly improved compared with those before pacing in control group.Conclusion:short atrioventricular interval physiological pacing may improve acute hemodynamic effect and echocardiography parameters in patients with heart failure.