Vernooy Kevin, Dijkman Barbara, Cheriex Emile C, Prinzen Frits W, Crijns Harry J G M
Department of Cardiology, Cardiovascular Research Institute Maastricht, University Hospital Maastricht, Maastricht, The Netherlands.
Am J Cardiol. 2006 Apr 15;97(8):1223-7. doi: 10.1016/j.amjcard.2005.11.044. Epub 2006 Feb 28.
To investigate ventricular remodeling during long-term right ventricular (RV) pacing after His bundle ablation (HBA) in patients with atrial arrhythmias, a retrospective analysis was performed on echocardiographic data from 45 patients (mean age 57 +/- 11 years) with atrial arrhythmias who underwent HBA and pacemaker implantation (HBA-PI) to control ventricular rate. Echocardiography was performed 1 year before HBA-PI, and up to 7 +/- 2 years of follow-up was conducted. An inverse linear relation was found between the relative increase of left ventricular (LV) end-diastolic diameter (EDD) during long-term RV pacing and LVEDD before HBA-PI (r = -0.61, p<0.001). Patients were divided into 2 groups: those with LVEDDs smaller than the mean LVEDD of 50 mm (group I, 46 +/- 2 mm, n = 28) and those with LVEDDs >50 mm (group II, 56 +/- 4 mm, n = 17). Before HBA-PI, patients in group I had significantly smaller LV weights (167 +/- 44 vs 238 +/- 56 g) and LV end-systolic diameters (30 +/- 2 vs 42 +/- 7 mm) and higher LV ejection fractions (64 +/- 5% vs 49+/- 12%) than those in group II. In group I, long-term RV pacing increased LVEDD, LV end-systolic diameter, LV weight, and left atrial diameter; increased mitral regurgitation; and decreased the LV ejection fraction and LV fractional shortening. No significant changes were observed during long-term RV pacing in group II. In conclusion, long-term RV pacing after HBA adversely affects LV structure and function in patients with initially normal LV dimensions and function.
为研究心房颤动患者希氏束消融（HBA）后长期右心室（RV）起搏期间的心室重构，对45例（平均年龄57±11岁）因心房颤动接受HBA及起搏器植入（HBA-PI）以控制心室率的患者的超声心动图数据进行回顾性分析。在HBA-PI前1年进行超声心动图检查，并进行长达7±2年的随访。发现长期RV起搏期间左心室（LV）舒张末期直径（EDD）的相对增加与HBA-PI前的LVEDD呈负线性关系（r = -0.61，p<0.001）。患者分为2组：LVEDD小于平均LVEDD 50 mm的患者（I组，46±2 mm，n = 28）和LVEDD>50 mm的患者（II组，56±4 mm，n = 17）。在HBA-PI前，I组患者的LV重量（167±44 vs 238±56 g）、LV收缩末期直径（30±2 vs 42±7 mm）显著小于II组，LV射血分数（64±5% vs 49±12%）显著高于II组。在I组中，长期RV起搏增加了LVEDD、LV收缩末期直径、LV重量和左心房直径；增加了二尖瓣反流；并降低了LV射血分数和LV缩短分数。II组在长期RV起搏期间未观察到显著变化。总之，HBA后长期RV起搏对初始LV大小和功能正常的患者的LV结构和功能有不利影响。
