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目的观察心脏再同步化治疗(CRT)对心力衰竭(HF)患者P波离散度(Pd)和心房高频事件(AHRE)的影响。方法选取2010年1月~2014年5月本院心内科收治的49例行CRT的HF患者,于术前、术后6个月和12个月行12导联心电图、动态心电图、超声心动图检查并定期随访,根据术后6个月NYHA心功能分级和超声心动图结果分为CRT有反应组和无反应组。结果有反应组33例(67%),无反应组16例(33%),与术前相比较,术后6个月,有反应组左室舒张末期内径(LVEDD)显著缩小,左室射血分数(LVEF)显著提高,室性早搏(VPB)显著减少(P<0.05),左房最大内径(LAD)、Pd、房性早搏(APB)、AHRE差异未见统计学意义,术后12个月,有反应组除LVEDD显著缩小,LVEF显著升高,VPB显著减少外(P<0.05),LAD、Pd显著减小、APB、AHRE显著减少(P<0.05)。无反应组术后6个月和12个月各参数与术前相比均未见统计学差异,有反应组术后12个月内总AHRE次数与术前Pd呈显著正相关(r=0.651,P=0.000),而与术前LAD无显著相关性(r=0.169,P=0.060)。结论CRT中远期效果可以改善心房重构和Pd、减少AHRE的发生,Pd是CRT后发生AHRE的强有力的预测因子。
Objective To observe the effect of cardiac resynchronization therapy (CRT) on P wave dispersion (Pd) and atrial high frequency event (AHRE) in patients with heart failure (HF). Methods From January 2010 to May 2014, 49 cases of HF patients undergoing CRT in our hospital were enrolled in this study. The 12-lead ECG, ambulatory electrocardiogram, echocardiogram and echocardiogram were performed preoperatively, 6 months and 12 months after operation. According to the NYHA functional class and echocardiographic results at 6 months after operation, the patients with CRT were divided into CRT-responsive group and non-responsive group. Results There were 33 cases (67%) in reaction group and 16 cases (33%) in non-reaction group. Compared with preoperative, 6 months after operation, the left ventricular end diastolic diameter (LVEDD) LVEF, APB and AHRE were significantly lower than those in control group (P <0.05). There were no significant differences in LAD, AP, In the response group, LVEDD was significantly reduced, LVEF was significantly increased, VPB was significantly decreased (P <0.05), LAD and Pd were significantly decreased, APB and AHRE were significantly decreased (P <0.05). There was no significant difference in parameters between 6 months and 12 months after operation in non-response group compared with that before operation. There was a significant positive correlation between the total number of AHRE and the preoperative Pd within 12 months after operation (r = 0.651 , P = 0.000), but no significant correlation with preoperative LAD (r = 0.169, P = 0.060). Conclusion The long-term effect of CRT can improve atrial remodeling and Pd, reduce the occurrence of AHRE, and Pd is a powerful predictor of AHRE after CRT.