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目的探讨单左室起搏通过频率适应性房室延迟(RAAV)算法跟踪生理性房室延迟(AVD)实现双心室再同步的可行性及治疗慢性充血性心力衰竭(CHF)的效果。方法入选符合心脏再同步化治疗(CRT)Ⅰ类适应证并植入带RAAV功能的三腔或双腔起搏器的CHF患者64例,其中RAAV单左室起搏(LUVP)组(单左室组)32例,以标准双室起搏(BVP)组(标准双室组)32例为对照组。两组给予标准心脏超声优化,比较主动脉前向血流速度时间积分(AVI),左室射血分数(LVEF)、十二节段达峰时间标准差(TS-SD12)、主肺动脉射血前时间差(IVMD)、二尖瓣返流面积(MRA)、EA峰间距(E/A pd)、QRS波时限、年平均治疗费用、NYHA分级、6min步行试验(6MWT)等指标。结果与标准双室组比较,单左室组电池寿命更长[(7.8±0.3)年vs(4.5±0.2)年,P<0.001],QRS波时限短[(136±10)ms vs(142±11)ms,P<0.05],优化耗时较短[(20±4)min vs(52±8)min,P<0.001],MRA更少[(3.1±1.1)cm~2 vs(3.7±1.2)cm2,P<0.05],IVMD缩短[(64.2±12.8)ms vs(72.3±13.6)ms,P<0.05],年均治疗费用低[(1.3±0.1)万元vs(2.2±0.2)万元,P<0.001];AVI增加[(21.8±2.3)cm vs(20.6±2.1)cm,P<0.05],余指标两组比较均无统计学意义(P>0.05)。结论 RAAV单左室起搏可实现双室再同步,疗效不劣于标准BVP,且更符合生理性并降低治疗费用。
Objective To investigate the feasibility and feasibility of single ventricular pacing for biventricular resynchronization following atrial-ventricular delay (AVD) by frequency-adaptive atrioventricular delay (RAAV) algorithm. Methods Sixty-four patients with CHF who underwent cardiorespiratory resuscitation (CRT) class I indications and were implanted with a three-chamber or dual-chamber pacemaker with RAAV were enrolled in this study. Among them, RAAV single left ventricular pacing (LUVP) Group), 32 cases were treated with BVP (standard double chamber group) and 32 cases as control group. Standard echocardiography was performed in both groups. AVI, LVEF, TS-SD12 in the twelve segments were compared. The difference of the time before ejection of the main pulmonary artery (IVMD), mitral valve regurgitation (MRA), EA peak distance (E / A pd), QRS wave duration, average annual cost of treatment, NYHA classification, 6min walk test (6MWT) and other indicators. Results Compared with the standard group, the battery life in single group was longer than that in the standard group ([7.8 ± 0.3] vs (4.5 ± 0.2) years, P <0.001] (11 ± 1.1) cm ~ 2 vs (3.7 ± 1.1) cm ~ (2) ± (11 ± 1) ms, P <0.05] ± 1.2) cm2, P <0.05], IVMD shortened [(64.2 ± 12.8) ms vs (72.3 ± 13.6) ms, P <0.05] ) (P <0.001); AVI increased [(21.8 ± 2.3) cm vs (20.6 ± 2.1) cm, P <0.05). There was no significant difference in the remaining indicators between the two groups (P> 0.05). Conclusion RAAV single left ventricular pacing can achieve double room resynchronization, the effect is not inferior to the standard BVP, and more in line with physiological and reduce the cost of treatment.