Garrigue S, Bordachar P, Reuter S, Jaïs P, Kobeissi A, Gaggini G, Haïssaguerre M, Clementy J
Hôpital Cardiologique du Haut-Leveque, University of Bordeaux, Bordeaux-Pessac, France Sorin Biomedica, 9, rue Georges Besse, Bat.4, 92160 Antony, France.
Heart. 2002 Jun;87(6):529-34. doi: 10.1136/heart.87.6.529.
To compare clinical and haemodynamic variables between left ventricular and biventricular pacing in patients with severe heart failure; and to analyse haemodynamic changes during daily life and maximum exercise during chronic left ventricular and biventricular pacing.
Prospective single blinded randomised study with crossover.
University hospital (tertiary referral centre).
13 patients (mean (SD) age, 62 (6) years) with chronic atrial fibrillation, severe heart failure (mean ejection fraction 24 (8)%), and QRS prolongation of > or = 140 ms had His bundle ablation and installation of a pacemaker providing left ventricular and biventricular pacing. The pacemaker was equipped with a peak endocardial acceleration (PEA) sensor. The PEA pattern was used as a haemodynamic marker during exercise as it is highly correlated with left ventricular dP/dt. After a baseline period of right ventricular pacing, all patients had two months of left ventricular pacing and two months of biventricular pacing in random order. At the end of each phase, an echocardiogram, a haemodynamic analysis at rest and on exercise during a six minute walk test, and a cardiopulmonary exercise test were performed.
PEA values were higher with left ventricular pacing (0.58 (0.38) m/s) and biventricular pacing (0.62 (0.24) m/s) than at baseline (0.49 (0.18) m/s) (p < 0.05). The six minute walk test showed similar performance in both pacing modes, but patients had more symptoms with left ventricular pacing at the end of the test (p = 0.035). On cardiopulmonary exercise testing, there was a greater increase in mean percentage variation of PEA with biventricular pacing than with left ventricular pacing (125 (18)% v 97 (36)%, respectively; p = 0.048) and better performance figures (92 (34) W v 77 (23) W; p = 0.03).
During symptom limited and daily life exercise tests, chronic biventricular pacing provides better haemodynamic performance than left ventricular pacing. In heart failure patients with wide QRS complexes, the interventricular dyssynchronisation induced by left ventricular pacing may impair myocardial function during exercise.
比较重度心力衰竭患者左心室起搏和双心室起搏的临床及血流动力学变量；分析慢性左心室起搏和双心室起搏期间日常生活及最大运动时的血流动力学变化。
前瞻性单盲交叉随机研究。
大学医院（三级转诊中心）。
13例患者（平均（标准差）年龄62（6）岁），患有慢性心房颤动、重度心力衰竭（平均射血分数24（8）%）且QRS波延长≥140毫秒，接受了希氏束消融并植入了可提供左心室起搏和双心室起搏的起搏器。该起搏器配备了峰值心内膜加速度（PEA）传感器。由于PEA模式与左心室dP/dt高度相关，因此在运动期间用作血流动力学标志物。在右心室起搏的基线期后，所有患者随机顺序接受两个月的左心室起搏和两个月的双心室起搏。在每个阶段结束时，进行超声心动图检查、六分钟步行试验期间静息和运动时的血流动力学分析以及心肺运动试验。
左心室起搏（0.58（0.38）米/秒）和双心室起搏（0.62（0.24）米/秒）时的PEA值高于基线时（0.49（0.18）米/秒）（p<0.05）。六分钟步行试验显示两种起搏模式下表现相似，但试验结束时患者在左心室起搏时有更多症状（p = 0.035）。在心肺运动试验中，双心室起搏时PEA的平均百分比变化增加幅度大于左心室起搏（分别为125（18）%对97（36）%；p = 0.048），且表现指标更好（92（34）瓦对77（23）瓦；p = 0.03）。
在症状受限和日常生活运动试验中，慢性双心室起搏比左心室起搏提供更好的血流动力学性能。在QRS波增宽的心力衰竭患者中，左心室起搏引起的心室间不同步可能会在运动期间损害心肌功能。
