心脏再同步治疗反应与房颤持续时间较短有关。

Cardiac resynchronization therapy response is associated with shorter duration of atrial fibrillation.

作者信息

Lellouche Nicolas, De Diego Carlos, Vaseghi Marmar, Buch Eric, Cesario David A, Mahajan Aman, Wiener Isaac, Fonarow Gregg C, Boyle Noel G, Shivkumar Kalyanam

机构信息

UCLA Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, University of California-Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.

出版信息

Pacing Clin Electrophysiol. 2007 Nov;30(11):1363-8. doi: 10.1111/j.1540-8159.2007.00872.x.

DOI:10.1111/j.1540-8159.2007.00872.x

PMID:17976100

Abstract

BACKGROUND

Atrial fibrillation (AF) is commonly associated with heart failure. The benefit of cardiac resynchronization therapy (CRT) on atrial remodeling has been demonstrated. However, biventricular pacing did not reduce the global incidence of AF. We evaluated the relationship between CRT response and AF duration.

METHODS

We retrospectively analyzed data from 96 patients (59 +/- 15 years; 78% male) who underwent CRT. All patients had class III-IV New York Heart Association (NYHA) symptoms despite maximal medical therapy, left ventricular ejection fraction (LVEF) < or = 35%, QRS >130 ms, and sinus rhythm before implantation. CRT response in patients who survived at six months of follow-up was defined as: (1) no hospitalization for heart failure and (2) improvement of one or more grades in the NYHA classification.

RESULTS

CRT responders (n = 54) and non-responders (n = 42) had similar baseline characteristics, including the incidence of persistent AF within six months before implantation. Six months after implantation, when compared to baseline, CRT responders exhibited a significant decrease in left atrial size (47.5 +/- 7.1 mm vs 44.6 +/- 7.7 mm, P < 0.01) and in the incidence of persistent AF (17% vs 2%, P = 0.02). At six months, CRT responders demonstrated shorter mean AF duration (7.5 +/- 43.3 hours vs 48.8 +/- 129.0 hours, P = 0.03) and lower incidence of persistent AF (2% vs 19%, P = 0.004) compared to nonresponders.

CONCLUSION

CRT response is associated with a reversal of atrial remodeling and a shorter AF duration.

摘要

背景

心房颤动（AF）通常与心力衰竭相关。心脏再同步治疗（CRT）对心房重构的益处已得到证实。然而，双心室起搏并未降低AF的总体发生率。我们评估了CRT反应与AF持续时间之间的关系。

方法

我们回顾性分析了96例接受CRT治疗的患者（年龄59±15岁；78%为男性）的数据。所有患者尽管接受了最大程度的药物治疗，但仍有纽约心脏协会（NYHA）III-IV级症状，左心室射血分数（LVEF）≤35%，QRS>130 ms，且植入前为窦性心律。随访6个月存活的患者的CRT反应定义为：（1）无因心力衰竭住院；（2）NYHA分级改善一级或更多级。

结果

CRT反应者（n = 54）和无反应者（n = 42）具有相似的基线特征，包括植入前6个月内持续性AF的发生率。植入后6个月，与基线相比，CRT反应者的左心房大小显著减小（47.5±7.1 mm对44.6±7.7 mm，P<0.01），持续性AF的发生率也显著降低（17%对2%，P = 0.02）。在6个月时，与无反应者相比，CRT反应者的平均AF持续时间更短（7.5±43.3小时对48.8±129.0小时，P = 0.03），持续性AF的发生率更低（2%对19%，P = 0.004）。