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目的:观察比较右室心尖部起搏(RVA)和双心室起搏(BIV)治疗对慢性心力衰竭伴永久性心房颤动患者心功能的影响。方法:选择因慢性心力衰竭伴永久性房颤需行永久性起搏器植入治疗的住院患者36例,随机分为RVA组和BIV组各18例。分别于术后1个月、6个月、12个月随访,评估NYHA分级,测定6min步行距离(6MWD),检测NT-proBNP水平;测量QRS波宽度,记录起搏比例;超声检查比较两组左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)以及有无二尖瓣反流(MR)。结果:(1)BIV组术后1个月、6个月、12个月QRS时限均显著短于RVA组(P<0.05);两组起搏比例差异不显著(P>0.05)。(2)术后1个月,BIV组NYHA分级显著低于术前及RVA组,6-MWD显著长于术前及RVA组(P<0.05);术后6个月、12个月,NYHA分级、NT-proBNP水平显著或非常显著低于术前及RVA组同时间节点(P<0.05,P<0.01),6-MWD非常显著长于术前及RVA组同时间节点(P<0.01)。(3)术后6个月、12个月,BIV组MR发生率、LVEDD显著降低且低于RVA组,LVEF显著增加且高于RVA组(P<0.05)。结论:对于有永久性起搏治疗适应证的慢性心力衰竭并发房颤患者,BIV起搏可逆转心肌重构,改善心功能,提高患者生活质量。
Objective: To observe the effects of RVA and BIV on cardiac function in patients with chronic heart failure and permanent atrial fibrillation. Methods: Thirty-six in-patients who underwent permanent pacemaker implantation for chronic heart failure and permanent atrial fibrillation were randomly divided into RVA group and BIV group, 18 cases each. The NYHA classification was assessed at 1 month, 6 months and 12 months after operation. The 6-minute walking distance (6MWD) was measured and the NT-proBNP level was measured. The width of QRS wave was measured and the pacing rate was recorded. Left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF), and presence or absence of mitral regurgitation (MR). Results: (1) The QRS time of BIV group was significantly shorter than that of RVA group at 1, 6 and 12 months after operation (P <0.05). There was no significant difference in pacing rate between two groups (P> 0.05). (2) NYHA classification in BIV group was significantly lower than that in preoperative and RVA groups at 1 month after surgery, and the 6-MWD was significantly longer than preoperative and RVA groups (P <0.05). NYHA classification at 6 and 12 months after operation (P <0.05, P <0.01). The 6-MWD was significantly longer than that of the preoperative and RVA groups (P <0.01). (3) The incidences of MR and LVEDD in BIV group were significantly lower than those in RVA group at 6 months and 12 months after operation. LVEF was significantly higher in BIV group than in RVA group (P <0.05). Conclusion: For patients with chronic heart failure and atrial fibrillation who have permanent pacing indications, BIV pacing can reverse myocardial remodeling, improve cardiac function and improve quality of life of patients.