Miyoshi Fumito, Kobayashi Youichi, Itou Hiroyuki, Onuki Tatsuya, Matsuyama Takaaki, Watanabe Norikazu, Liu Chungchang, Kawamura Mitsuharu, Asano Taku, Miyata Akira, Nakagawa Haruyuki, Tanno Kaoru, Baba Takao, Katagiri Takashi
Third Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan.
Pacing Clin Electrophysiol. 2005 Nov;28(11):1182-8. doi: 10.1111/j.1540-8159.2005.50181.x.
The recent studies showed that right ventricular (RV) pacing was associated with worsening of heart failure. The aim of this study is to clarify the clinical significance of paced QRS duration during RV pacing to predict congestive heart failure (CHF) patients.
This study enrolled in 92 patients with atrioventricular block who underwent initial pacemaker implantation. The paced QRS duration was automatically obtained by electrocardiography immediately after pacemaker implantation and then by routine attendance at a pacemaker clinic every 3 months. The paced QRS duration was positively correlated with left ventricular end-diastolic dimension (P < 0.05) and left ventricular end-systolic dimension (P < 0.05), and tended to negatively correlate with left ventricular ejection fraction (P = 0.0507). The paced QRS duration immediately after pacemaker implantation was 170.4 +/- 18.9 ms. During a mean follow-up period of 53 +/- 16 months, 16 patients developed CHF. We selected as a cut-off value the nearest whole number (190 ms) that was one standard deviation greater than the mean, and divided into two groups according to baseline paced QRS duration. Patients with a paced QRS duration of <190 ms comprised group A (n = 77, nine of which developed CHF) and the remainder comprised group B (n = 15, seven of which developed CHF). Prolonged paced QRS duration (> or =190 ms) was associated with a significant increase in the overall morbidity of CHF (P < 0.05). Additionally, paced QRS duration significantly prolonged during the follow-up period among group A patients with CHF (P < 0.05), but did not change among patients without CHF.
We concluded that paced QRS duration can be a useful indicator of impaired left ventricular function in patients with RV pacing. Even in patients whose paced QRS duration is relatively shorter, progressive prolongation of paced QRS duration can predict the development of CHF.
近期研究表明，右心室（RV）起搏与心力衰竭的恶化有关。本研究的目的是阐明RV起搏期间起搏QRS波时限对预测充血性心力衰竭（CHF）患者的临床意义。
本研究纳入了92例接受初次起搏器植入的房室传导阻滞患者。起搏器植入后立即通过心电图自动获取起搏QRS波时限，随后每3个月在起搏器门诊常规检查时获取。起搏QRS波时限与左心室舒张末期内径呈正相关（P < 0.05），与左心室收缩末期内径呈正相关（P < 0.05），且与左心室射血分数呈负相关趋势（P = 0.0507）。起搏器植入后立即测得的起搏QRS波时限为170.4±18.9毫秒。在平均53±16个月的随访期内，16例患者发生了CHF。我们选择比平均值大一个标准差的最接近整数（190毫秒）作为截断值，并根据基线起搏QRS波时限将患者分为两组。起搏QRS波时限<190毫秒的患者组成A组（n = 77，其中9例发生CHF），其余患者组成B组（n = 15，其中7例发生CHF）。起搏QRS波时限延长（≥190毫秒）与CHF总体发病率显著增加相关（P < 0.05）。此外，A组发生CHF的患者在随访期间起搏QRS波时限显著延长（P < 0.05），而未发生CHF的患者起搏QRS波时限无变化。
我们得出结论，起搏QRS波时限可作为RV起搏患者左心室功能受损的有用指标。即使是起搏QRS波时限相对较短的患者，起搏QRS波时限的进行性延长也可预测CHF的发生。
