Fei L, Wrobleski D, Groh W, Vetter A, Duffin E G, Zipes D P
Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Roudebush Veterans Administration Medical Center, Indianapolis, USA.
J Cardiovasc Electrophysiol. 1999 Jul;10(7):935-46. doi: 10.1111/j.1540-8167.1999.tb01264.x.
We studied the effects on cardiac function of pacing two right and two left ventricular sites in normal and failing hearts with a normal QRS duration.
Hemodynamic parameters were studied in isoflurane-anesthetized dogs with normal hearts and dogs with heart failure induced by rapid ventricular pacing. Unipolar intramyocardial electrodes were placed at the high right atrium and the apex (A) and base (B) of the left (L) and right (R) ventricles (V). Data were collected after pacing for 5 to 20 minutes. In normal dogs, without bundle branch block (BBB), pacing at either the apex or the base of the left ventricle increased cardiac output by approximately 10% compared with right ventricular apex (RVA) pacing with an AV delay of 0 msec. Positive dP/dt increased approximately 10% during four-site left and right ventricular apex and base (LRVAB) pacing compared with RVA pacing. In dogs with heart failure but without BBB, cardiac output increased by 8.5% (P < 0.01) during four-site ventricular pacing with AV delays of 0 and 60 msec compared with RVA pacing. Positive dp/dt increased by 23.5% (P < 0.001) with an AV delay of 0 msec and 9.6% (P < 0.001) with an AV delay of 60 msec during LRVAB pacing compared with RVA pacing. His-bundle pacing was associated with increased cardiac output compared with RVA pacing.
We conclude that pacing simultaneously at two right and two left ventricular sites significantly improves cardiac function compared with single RVA pacing, with or without sequential AV synchrony, in dogs with rapid ventricular pacing-induced heart failure and no BBB.
我们研究了在QRS时限正常的正常心脏和衰竭心脏中，对右心室和左心室两个部位进行起搏对心脏功能的影响。
在异氟烷麻醉下的正常心脏犬和快速心室起搏诱导心力衰竭的犬中研究血流动力学参数。将单极心内膜电极置于右心房高位以及左、右心室的心尖（A）和心底（B）。起搏5至20分钟后收集数据。在无束支传导阻滞（BBB）的正常犬中，与右心室心尖（RVA）以0毫秒的房室延迟起搏相比，在左心室心尖或心底起搏可使心输出量增加约10%。与RVA起搏相比，在左右心室心尖和心底（LRVAB）四点起搏期间，dp/dt正值增加约10%。在无BBB的心力衰竭犬中，与RVA起搏相比，在房室延迟为0和60毫秒的四点心室起搏期间，心输出量增加了8.5%（P<0.01）。与RVA起搏相比，在LRVAB起搏期间，房室延迟为0毫秒时dp/dt正值增加23.5%（P<0.001），房室延迟为60毫秒时增加9.6%（P<0.001）。与RVA起搏相比，希氏束起搏与心输出量增加有关。
我们得出结论，在快速心室起搏诱导心力衰竭且无BBB的犬中，与单RVA起搏相比，同时对右心室和左心室两个部位进行起搏可显著改善心脏功能，无论是否有顺序性房室同步。
