右心房、左心室起搏治疗慢性心力衰竭伴左束支传导阻滞患者的短期疗效

摘要

目的:观察右心房、左心室起搏治疗慢性心力衰竭(心衰)伴左束支传导阻滞患者的短期疗效.方法:选择纽约心功能分级(NYHA)Ⅲ级～Ⅳ级、左心室射血分数≤0.35、体表心电图QRS时限≥120 ms、窦性心律的心衰患者26例,成功植入三腔起搏器后,以右心房、左心室起搏模式治疗7天,以起搏器植入术前及术后第7天的6分钟步行距离、明尼苏达生活质量评分、QRS波时限、左心室舒张末期内径、左心室射血分数、左心室室间隔部与侧壁基底段收缩期达峰时间差值、N末端脑钠肽为疗效评价指标,观察右心房、左心室起搏治疗慢性心衰的短期疗效.结果:右心房、左心室起搏治疗术后第7天较术前比较,6分钟步行距离由术前的( 279±46)m提高至(312±37)m；明尼苏达生活质量评分由术前的(28±7)下降至(22±5)；体表心电图QRS波时限由术前的(167±22)ms缩短至(132±8)ms;左心室射血分数由术前的(0.29±0.07)提高至(0.33±0.05)；左心室舒张末期内径由术前的(75±8)mm减小至(69±7)mm；左心室室间隔部与侧壁基底段收缩期达峰时间差值由术前的(105±29)ms下降至(62±8)ms；N末端脑钠肽由术前的(3 086±1 265)pg/ml下降至(1 976±760)pg/ml；患者的各疗效评价指标均得到明显改善,差异均有统计学意义(P＜0.05).结论:对窦性心律、完全性左束支传导阻滞的慢性心衰患者右心房、左心室起搏的短期疗效确切.%Objective:To observe the short-term effect of right atrial and left uni-ventricular pacing in patients of chronic heart failure with left bundle-branch block.Methods; A total of 26 heart failure patients who had NYHA class III to IV .with sinus rhythm,left ventricular ejection fraction (LVEF) ≤ 0. 35, QRS duration ≥s 0. 12 ms were studied after successful implantation of CRT/CRTD. All patients received right atrial and left uni-ventricular pacing for 7 days. The therapeutic effects were evaluated with 6-minute walking distance, Minnesota quality-of-life score (MQOL) , QRS duration, left ventricular end-diastolic dimension (LVEDD), LVEF, the difference between systolic time to peak from left inter ventricular septum to the basal segment of lateral wall (TPSD) and N-terminal pro-B-tvpe natriuretic peptide (NT-proBNP)before, and 7 days after the implantation.Results:With 7 days of pacing, all the above index were significantly improved than it was before,the 6-minute walking distance increased from (279±46) m to (312±37) m, MQOL score decreased from (28±7) to (22±5), QRS duration shortened from (167±22) ms to (132±8) ms, LVEF increased from (0. 29±0.07) to (0. 33±0. 05), LVEDD reduced from (75±8) mm to (69±7) mm, TPSD dropped from (105±29) ms to (62±8) ms and NT-proBNP decreased from (3086±1 265) pg/ml to (1 976±760) pg/ml,P<0.05 respectively.Conclusion: Right atrial and left uni-ventricular pacing has definite short-term therapeutic effect in patients of sinus rhythm,chronic heart failure with left bundle-branch block.