Auricchio Angelo, Stellbrink Christoph, Sack Stefan, Block Michael, Vogt Jürgen, Bakker Patricia, Huth Christof, Schöndube Friedrich, Wolfhard Ulrich, Böcker Dirk, Krahnefeld Olaf, Kirkels Hans
Department of Cardiology, University Hospital, Magdeburg, Germany.
J Am Coll Cardiol. 2002 Jun 19;39(12):2026-33. doi: 10.1016/s0735-1097(02)01895-8.
We sought to compare the short- and long-term clinical effects of atrial synchronous pre-excitation of one (univentricular) or both ventricles (biventricular), that provide cardiac resynchronization therapy (CRT).
In patients with heart failure (HF) who have a ventricular conduction delay, CRT improves systolic hemodynamic function. The clinical benefit of CRT is still being investigated.
Forty-one patients were randomized to four weeks of first treatment with biventricular or univentricular stimulation, followed by four weeks without treatment, and then four weeks of a second treatment with the opposite stimulation. The best CRT stimulation was continued for nine months. Cardiac resynchronization therapy was optimized by hemodynamic testing at implantation. The primary end points were exercise capacity measures. Data were analyzed by two-way repeated-measures analysis of variance.
The left ventricle was selected for univentricular pacing in 36 patients. The clinical effects of univentricular and biventricular CRT were not significantly different. The results of each method were pooled to assess sequential treatment effects. Oxygen uptake during bicycle exercise increased from 9.48 to 10.4 ml/kg/min at the anaerobic threshold (p = 0.03) and from 12.5 to 14.3 ml/kg/min at peak exercise (p < 0.001) with the first treatment, and from 10.0 to 10.7 ml/kg/min at the anaerobic threshold (p = 0.2) and from 13.4 to 15.2 ml/kg/min at peak exercise (p = 0.002) with the second treatment. The 6-min walk distance increased from 342 m at baseline to 386 m after the first treatment (p < 0.001) and to 416 m after the second treatment (p = 0.03). All improvements persisted after 12 months of therapy.
Cardiac resynchronization therapy produces a long-term improvement in the clinical symptoms of patients with HF who have a ventricular conduction delay. The differences between optimized biventricular and univentricular therapy appear to be small for short-term treatment.
我们试图比较单心室或双心室心房同步预激（提供心脏再同步治疗，即CRT）的短期和长期临床效果。
在患有心室传导延迟的心力衰竭（HF）患者中，CRT可改善收缩期血流动力学功能。CRT的临床益处仍在研究中。
41例患者被随机分为两组，先接受四周的双心室或单心室刺激首次治疗，随后四周不治疗，然后接受四周的相反刺激第二次治疗。最佳的CRT刺激持续九个月。通过植入时的血流动力学测试优化心脏再同步治疗。主要终点是运动能力指标。数据采用双向重复测量方差分析进行分析。
36例患者选择左心室进行单心室起搏。单心室和双心室CRT的临床效果无显著差异。将每种方法的结果汇总以评估序贯治疗效果。首次治疗时，无氧阈值下自行车运动时的摄氧量从9.48增加到10.4 ml/kg/min（p = 0.03），峰值运动时从12.5增加到14.3 ml/kg/min（p < 0.001）；第二次治疗时，无氧阈值下从10.0增加到10.7 ml/kg/min（p = 0.2），峰值运动时从13.4增加到15.2 ml/kg/min（p = 0.002）。6分钟步行距离从基线时的342米增加到首次治疗后的386米（p < 0.001），第二次治疗后增加到416米（p = 0.03）。治疗12个月后，所有改善均持续存在。
心脏再同步治疗可长期改善患有心室传导延迟的HF患者的临床症状。优化的双心室和单心室治疗在短期治疗中的差异似乎很小。
