中国全科医学2017，Vol.20Issue(2)：133-138,6.DOI:10.3969/j.issn.1007-9572.2017.02.003
单左心室起搏通过频率适应性房室延迟改善慢性充血性心力衰竭患者血流动力学的效果研究
Effects of Left Univentricular Pacing through Rate Adaptive Atrio - ventricular Delay on Improving Hemodynamics of Patients with Chronic Congestive Heart Failure
摘要
Abstract
Objective To achieve left univentricular pacing by dual - chamber pacemaker,to track the physiological atrio - ventricular delay by rate adaptive atrio - ventricular delay(RAAVD)and to explore the effect of left univentricular pacing using RAAVD in achieving double ventricular resynchronization therapy on hemodynamics of patients with chronic congestive heart failure(CHF). Methods Sixty - eight patients with CHF,who received treatment in Department of Cardiology of First Affiliated Hospital of Kunming Medical University from March 2013 to March 2016,were selected in the study. They were divided into left univentricular pacing RAAVD group( adopting left univentricular pacing RAAVD mode)and standardized biventricular pacing group(using standardized biventricular pacing mode)by random number table method. Each group had 34 cases. The echocardiographic indicators of preoperative and postoperative cardiac resynchronization therapy ( CRT) among patients in two groups were detected. The detected indicators included left ventricular ejection fraction(LVEF),left ventricular end - diastolic dimension(LVEDD),mitral regurgitation area(MRA),velocity - time integral of forward flow of aortic valve (AVVTI),E/ A peak duration(E/ A Pd),inter - ventricular mechanical delay(IVMD)and standardized deviation of time intervals of the 12 left ventricular segments(Ts-SD12). Results All patients had no complications such as pneumothorax and capsular infection after pacemaker implantation. The average follow - up period was(17. 3 ± 9. 6)months. One patient died during the follow - up of left univentricular pacing RAAVD group. Three patients died during the follow - up of the standardized biventricular pacing group. There was no significant difference in LVEF,LVEDD,E/ A Pd and Ts-SD12 between the two groups (P > 0. 05);the postoperative MRA and IVMD of left univentricular pacing RAAVD group were lower than those of standardized biventricular pacing group,while AVVTI was higher than that of standardized biventricular pacing group( P < 0. 05). The postoperative LVEF and AVVTI between two groups were higher than those before operation,while the postoperative LVEDD, MRA and Ts-SD12 were lower than those before operation( P < 0. 05);the postoperative IVMD of left univentricular pacing RAAVD group was lower than that before operation( P < 0. 05). Conclusion The application of RAAVD function of left univentricular pacing has achieved a safe and feasible physiological pacing,which makes biventricular systolic resynchronization and improve the hemodynamics of patients with CHF. Its effect is not inferior to standardized biventricular pacing.关键词
心力衰竭/心脏再同步疗法/血流动力学/频率适应性房室延迟/单左心室起搏Key words
Heart failure/Cardiac resynchronization therapy/Hemodynamics/Rate adaptive atrio - ventricular delay/Left univentricular pacing分类
医药卫生引用本文复制引用
赵璐露,蒲里津,赵玲,王钰,华宝桐,郭涛..单左心室起搏通过频率适应性房室延迟改善慢性充血性心力衰竭患者血流动力学的效果研究[J].中国全科医学,2017,20(2):133-138,6.基金项目
国家自然科学基金资助项目（81360044）；云南省科技厅资助项目（2013FB133）---昆明医科大学联合专项基金 （）
