Butter Christian, Wellnhofer Ernst, Seifert Martin, Schlegl Michael, Hoersch Walter, Goehring Alexander, Fleck Eckart
German Heart Institute, Berlin, Germany.
Am Heart J. 2006 Jan;151(1):115-23. doi: 10.1016/j.ahj.2005.02.047.
This study evaluates the acute and chronic resynchronizing effects of AV sequential left ventricular (LV) pacing on LV function in patients with impaired cardiac function and conduction disorders by 3-dimensional transesophageal echocardiography.
Twenty-nine patients with congestive heart failure, with LV ejection fraction (LVEF) < or = 30%, QRS duration > or = 120 milliseconds, and New York Heart Association Class II to IV, were implanted with a cardiac resynchronization device using an LV lead only, according to the invasively determined hemodynamic optimal pacing site and AV delay. Patients underwent 3-dimensional transesophageal echocardiography before randomization to treatment (baseline) and at 12-month follow-up (resynchronization--12 months). Three-dimensional volumes were acquired on resynchronization and during intermittent switch-off at intrinsic depolarization. The values of stroke volume were 43.2 +/- 13.3 (intrinsic-baseline), 51.7 +/- 17.4 (intrinsic--12 months), 57.2 +/- 15.6 (resynchronization-baseline), and 64.6 +/- 18.9 (resynchronization--12 months). Analysis of variance demonstrated a significant effect of resynchronization at different periods (P < .001) and a significant time effect (P < .05) for stroke volume. Similar results were observed with ejection fraction (LVEF). No effect was observed with LV end-diastolic volume, whereas a therapy effect with no time effect was observed with LV end-systolic volume.
A significant acute increase of LV stroke volume and LVEF was found by resynchronization by LV pacing alone. A continuous improvement of LV stroke volume and LVEF occurred with time of follow-up (reverse remodeling). The initial therapeutic effect persisted during 12-month follow-up independently of time of follow-up and QRS width. No significant decrease of LV end-diastolic size during chronic resynchronization was detected in contrast to previous studies with resynchronization by biventricular pacing.
本研究通过三维经食管超声心动图评估房室顺序左心室（LV）起搏对心功能受损和传导障碍患者左心室功能的急性和慢性再同步化作用。
29例充血性心力衰竭患者，左心室射血分数（LVEF）≤30%，QRS时限≥120毫秒，纽约心脏协会心功能分级为II至IV级，根据有创测定的血流动力学最佳起搏部位和房室延迟，仅使用左心室导线植入心脏再同步装置。患者在随机分组接受治疗前（基线）和12个月随访时（再同步化 - 12个月）接受三维经食管超声心动图检查。在再同步化时以及内在去极化期间间歇性关闭时获取三维容积。每搏量的值分别为43.2±13.3（内在 - 基线）、51.7±17.4（内在 - 12个月）、57.2±15.6（再同步化 - 基线）和64.6±18.9（再同步化 - 12个月）。方差分析显示不同时期再同步化对每搏量有显著影响（P <.001）以及每搏量有显著的时间效应（P <.05）。左心室射血分数（LVEF）观察到类似结果。左心室舒张末期容积未观察到影响，而左心室收缩末期容积观察到无时间效应的治疗效果。
仅通过左心室起搏再同步化发现左心室每搏量和LVEF有显著急性增加。随着随访时间的推移，左心室每搏量和LVEF持续改善（逆向重构）。最初的治疗效果在12个月随访期间持续存在，与随访时间和QRS宽度无关。与先前双心室起搏再同步化研究相比，慢性再同步化期间未检测到左心室舒张末期大小显著减小。
