Tops Laurens F, Schalij Martin J, Holman Eduard R, van Erven Lieselot, van der Wall Ernst E, Bax Jeroen J
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
J Am Coll Cardiol. 2006 Oct 17;48(8):1642-8. doi: 10.1016/j.jacc.2006.05.072. Epub 2006 Sep 27.
This study was designed to assess the effects of long-term right ventricular (RV) pacing on left ventricular (LV) dyssynchrony, LV function, and heart failure symptoms.
Atrioventricular (AV) node ablation and subsequent long-term RV pacing is a well-established treatment option in patients with atrial fibrillation (AF).
In 55 patients with drug-refractory AF, AV node ablation and implantation of a pacemaker was performed. At baseline and after a mean of 3.8 +/- 1.7 years, LV dyssynchrony (by M-mode echocardiography and tissue Doppler imaging), LV function, and volumes and functional status were assessed.
After long-term RV pacing, 27 patients (49%) had developed LV dyssynchrony. Concomitantly, these patients worsened in heart failure symptoms (New York Heart Association functional class increased from 1.8 +/- 0.6 to 2.2 +/- 0.7, p < 0.05), with a decrease in LV ejection fraction (from 48 +/- 7% to 43 +/- 7%, p < 0.05) and an increase in LV end-diastolic volume (from 116 +/- 39 ml to 130 +/- 52 ml, p < 0.05). Conversely, patients without LV dyssynchrony did not deteriorate in heart failure symptoms, LV function, or LV volumes.
Long-term RV pacing can induce LV dyssynchrony in almost 50% of patients treated with AV node ablation for chronic AF. The development of LV dyssynchrony was associated with deterioration in heart failure symptoms, systolic LV function, and LV dilatation.
本研究旨在评估长期右心室（RV）起搏对左心室（LV）不同步性、左心室功能和心力衰竭症状的影响。
房室（AV）结消融及随后的长期右心室起搏是心房颤动（AF）患者公认的治疗选择。
对55例药物难治性AF患者进行房室结消融并植入起搏器。在基线时以及平均3.8±1.7年后，评估左心室不同步性（通过M型超声心动图和组织多普勒成像）、左心室功能、容积和功能状态。
长期右心室起搏后，27例患者（49%）出现左心室不同步性。与此同时，这些患者的心力衰竭症状恶化（纽约心脏协会功能分级从1.8±0.6升至2.2±0.7，p<0.05），左心室射血分数降低（从48±7%降至43±7%，p<0.05），左心室舒张末期容积增加（从116±39 ml增至130±52 ml，p<0.05）。相反，无左心室不同步性的患者心力衰竭症状、左心室功能或左心室容积未恶化。
长期右心室起搏可使近50%接受慢性AF房室结消融治疗的患者发生左心室不同步性。左心室不同步性的发生与心力衰竭症状恶化、左心室收缩功能和左心室扩张有关。
