Teo W S, Kam R, Hsu L F
Department of Cardiology, National Heart Centre, Mistri Wing, 17 Third Hospital Avenue, Singapore 168752.
Singapore Med J. 2003 Mar;44(3):114-22.
Patients with heart failure may have conduction abnormalities in up to 30%, further aggravating cardiac output. Drugs worsen these abnormalities and resynchronisation therapy with biventricular pacing improves cardiac function by effecting a more coordinated and efficient ventricular contraction. We report here the technique of biventricular pacing and its results.
Patients with NYHA Class III to IV heart failure, widened QRS (> or = 130 ms) complex on the ECG and impaired LVEF < or = 40% were enrolled.
Biventricular pacing was performed in 29 patients (26 males, three females) from August 1999 to December 2001. The mean age of the patients was 59.6 +/- 12.8 years and 62% had underlying ischemic heart disease. All were in NYHA class III or more. Twenty-three had LBBB, four RBBB and two had widened paced QRS complex. The QRS duration was 161 +/- 21 ms and LVEF was 22 +/- 8%. All the left ventricular leads were implanted successfully. The procedure time was 167.0 +/- 79.6 mins and the fluoroscopy time was 43.8 +/- 41.4 mins. There were no significant complications. The NYHA class improved from a mean of 3.1 to 2.0 and exercise time from 252 +/- 95 seconds to 392 +/- 152 seconds at six months post implant (p=0.049). On follow-up (one month to 28 months), 25 (86%) patients had improvement in heart failure symptoms and 26 (90%) of the patients remained alive.
Biventricular pacing can be safely performed and results in improvement in symptoms and exercise tolerance in heart failure patients with ventricular dyssynchrony not responding to drug therapy.
高达30%的心力衰竭患者可能存在传导异常，这会进一步加重心输出量。药物会使这些异常恶化，而双心室起搏的再同步治疗通过实现更协调、高效的心室收缩来改善心脏功能。我们在此报告双心室起搏技术及其结果。
纳入纽约心脏协会（NYHA）心功能III至IV级、心电图上QRS波增宽（≥130毫秒）且左心室射血分数（LVEF）受损（≤40%）的患者。
1999年8月至2001年12月，对29例患者（26例男性，3例女性）进行了双心室起搏。患者的平均年龄为59.6±12.8岁，62%患有潜在的缺血性心脏病。所有患者均为NYHA III级或更高级别。23例患者为左束支传导阻滞（LBBB），4例为右束支传导阻滞（RBBB），2例起搏QRS波增宽。QRS波持续时间为161±21毫秒，LVEF为22±8%。所有左心室导联均成功植入。手术时间为167.0±79.6分钟，透视时间为43.8±41.4分钟。无显著并发症。植入后6个月时，NYHA心功能分级从平均3.1级改善至2.0级，运动时间从252±95秒增加至392±152秒（p = 0.049）。随访（1个月至28个月）时，25例（86%）患者心力衰竭症状改善，26例（90%）患者存活。
双心室起搏可安全进行，并能改善药物治疗无效的心室不同步心力衰竭患者的症状和运动耐量。
