论文部分内容阅读
目的:探讨频率适应性房室延迟功能在双腔起搏器行右房-左室(RA-LV)起搏治疗慢性充血性心力衰竭(congestive heart failure,CHF)中的临床疗效。方法:选择30例符合心脏再同步化治疗(cardiac resynchronization therapy,CRT)Ⅰa类适应证的CHF患者(NYHA分级Ⅲ-Ⅳ级),随机分为右房-左室起搏(RA-LV)组及双室起搏(Biv)组,各15例。RA-LV组患者植入带频率适应性房室延迟(rate adaptive atrio-ventricular,RAAV)功能的双腔起搏器,通过RAAV算法跟踪生理性房室延迟(atrial ventricular delay,AVD)达到双心室再同步;Biv组植入三腔起搏器行双室起搏。观察两组患者起搏治疗前、治疗后左室舒张末期内径(left ventricular end diastolic diameter,LVDd)、左室射血分数(left ventricular ejection fraction,LVEF)、二尖瓣返流面积(mitral regurgitation area,MRA)、左室12节段达峰时间标准差(standard deviation of time intervals of the 12 left ventricular segments,Ts-SD12)、EA峰间距(E/A peak period,E/Apd)、主、肺动脉射血时间差的变化及QRS波时限、电池寿命、6 min步行试验(six minutes walk test,6 MWT)等指标。结果:与Biv组比较,RA-LV组QRS波时限较短(P<0.05),MRA更小(P<0.05),起搏器电池寿命更长(P<0.001),年均治疗费用低(P<0.001);两组患者LVDd、E/APd、LVEF、Ts-SD12及主、肺动脉射血时间差等指标比较,差异均无统计学意义(P>0.05)。结论:双腔起搏器行RA-LV起搏,通过RAAV功能可较好达到心脏再同步化,可改善CHF患者的心功能,节约治疗成本。
Objective: To investigate the clinical efficacy of frequency-adaptive atrioventricular delay in the treatment of congestive heart failure (CHF) with right atrial-left ventricular (RA-LV) pacing under dual chamber pacemaker. Methods: Thirty CHF patients (NYHA class Ⅲ-Ⅳ) with cardiac resynchronization therapy (CRT) class Ⅰa were randomly divided into right atrial-left ventricular pacing group (RA-LV) And biventricular pacing (Biv) group, 15 cases each. The RA-LV group was implanted with a dual-chamber pacemaker with frequency-adaptive atrio-ventricular (RAAV) function. The atrial ventricular delay (AVD) Resynchronization; Biv group implanted three-chamber pacemaker line double-chamber pacing. The left ventricular end diastolic diameter (LVDd), left ventricular ejection fraction (LVEF), mitral regurgitation area , MRA), standard deviation of time intervals of the 12 left ventricular segments (Ts-SD12), E / A peak period (E / Apd), main and pulmonary ejection Time difference and QRS wave duration, battery life, 6 min walk test (6 MWT) and other indicators. Results Compared with the Biv group, the duration of QRS wave in RA-LV group was shorter (P <0.05), MRA was smaller (P <0.05), and the pacemaker battery life was longer (P <0.001) P <0.001). There was no significant difference in the indexes of LVDd, E / APd, LVEF, Ts-SD12 between the two groups and the time difference between the main and pulmonary artery ejection (P> 0.05). Conclusion: The double-chamber pacemaker can be used to RA-LV pacing, which can achieve cardiac resynchronization through RAAV function. It can improve the cardiac function of CHF patients and save the treatment cost.