Chen Shao-liang, Dai Zhen-lin, Li Zhan-quan, Hu Zuo-Ying, Ye Fei, Zhang Jun-jie, Zhang Fen-fu, Luo Jun, Zhu Zhong-sheng, Lin Song, Wu Cheng-quan, Tian Nai-liang
Department of Cardiology, Nanjing First Hospital of Nanjing Medical University, Nanjing 210006, China.
Chin Med J (Engl). 2007 Apr 5;120(7):562-8.
Hypertrophic obstructive cardiomyopathy (HOCM) carries an increased risk for sudden cardiac death. No data regarding the percutaneous transseptal myocardial ablation (PTSMA) and epicardial left ventricular pacing (LVP) were reported.
Seven patients with recurrent symptoms and increased resting left ventricular outflow tract pressure gradient (LVOTG) after PTSMA and another 14 patients with HOCM without history of PTSMA were studied. Both resting and dobutamine stress echocardiography, PTSMA and LVP were routinely performed.
In patients without previous PTSMA procedure, mild reduction of resting LVOTG was detected at 5 minutes after left ventricular pacing, and this reduction became significant at 10 minutes. All patients were divided into successful and unsuccessful groups according to their response to LVP. In contrary to patients in unsuccessful group, resting and R-S2 stimuli-induced LVOTG during PTSMA procedure were decreased dramatically ((9 +/- 5) mmHg vs (58 +/- 12) mmHg, (12 +/- 2) mmHg vs (113 +/- 27) mmHg, P < 0.001). Analysis of Logistic regression demonstrated that only LVOTG level during left ventricular pacing was an independent factor predicting the reduction of LVOTG immediately after PTSMA (odds ratio (OR), 0.59; 95% CI 2.67 to 5.82; P = 0.0002).
Left ventricular endocardial temporary pacing plays a critical role in predicting acute effect on the reduction of LVOTG immediately after PTSMA procedure.
肥厚型梗阻性心肌病（HOCM）发生心源性猝死的风险增加。尚无关于经皮经间隔心肌消融术（PTSMA）和心外膜左心室起搏（LVP）的数据报道。
研究了7例PTSMA术后复发症状且静息左心室流出道压力阶差（LVOTG）升高的患者以及另外14例无PTSMA病史的HOCM患者。常规进行静息和多巴酚丁胺负荷超声心动图、PTSMA和LVP检查。
在未行PTSMA手术的患者中，左心室起搏后5分钟静息LVOTG轻度降低，10分钟时降低显著。所有患者根据其对LVP的反应分为成功组和失败组。与失败组患者相反，PTSMA手术期间静息和R-S2刺激诱发的LVOTG显著降低（（9±5）mmHg对（58±12）mmHg，（12±2）mmHg对（113±27）mmHg，P<0.001）。Logistic回归分析表明，只有左心室起搏期间的LVOTG水平是预测PTSMA术后即刻LVOTG降低的独立因素（比值比（OR），0.59；95%可信区间2.67至5.82；P=0.0002）。
左心室内膜临时起搏在预测PTSMA术后即刻LVOTG降低的急性效应中起关键作用。
