Nägele Herbert, Rödiger Wilfried, Castel Maria Angeles
Medical Department, Hamburger Str. 41, St Adolfstift, Reinbek D-21465, Germany.
Europace. 2008 Oct;10(10):1182-8. doi: 10.1093/europace/eun213. Epub 2008 Aug 21.
Chronotropic incompetence (CI) in patients with congestive heart failure (CHF) develops frequently under beta-blocker and amiodarone therapy. It can be corrected by pacing. We performed a randomized study to test whether pacing is beneficial in CHF patients with CI.
Congestive heart failure patients under combined beta-blocker and amiodarone therapy (n = 77) were randomly assigned to inhibited pacing (INH; basal rate 40 bpm/hysteresis 30 bpm; n = 38) or to DDDR pacing with optimized atrioventricular delay (OPT; stimulation rate 65-120 bpm, n = 39). Groups showed similar baseline values in NYHA class, heart rate, and ejection fraction (EF) and were followed up to 10 years. The resting and mean 24 h heart rate after 1 year decreased by -2.6/-5 bpm in INH, but increased by +3.6/+6.0 bpm in the OPT group (P < 0.001). The QRS interval after 1 year increased by 12 +/- 23 ms in the INH group, but +32 +/- 36 ms in the OPT group (P < 0.01). Patients with INH developed a greater left ventricular EF (LVEF) when compared with OPT patients (+10.6 +/- 8 vs. +2 +/- 10%, respectively; P = 0.04). Changes in LVEF were negatively correlated with heart rate, but not with QRS width changes. Prognosis and the event rate were better in the INH group.
In the long-term follow-up, single-site ventricular pacing in patients with CHF and low LVEF is associated with significant clinical events and a poor prognosis.
充血性心力衰竭（CHF）患者在β受体阻滞剂和胺碘酮治疗下常出现变时性功能不全（CI）。可通过起搏进行纠正。我们进行了一项随机研究，以测试起搏对伴有CI的CHF患者是否有益。
接受β受体阻滞剂和胺碘酮联合治疗的充血性心力衰竭患者（n = 77）被随机分配至抑制性起搏组（INH；基础心率40次/分钟/滞后30次/分钟；n = 38）或优化房室延迟的DDDR起搏组（OPT；刺激频率65 - 120次/分钟，n = 39）。两组在纽约心脏协会（NYHA）分级、心率和射血分数（EF）方面基线值相似，并随访10年。1年后，INH组静息和平均24小时心率分别下降了-2.6 / -5次/分钟，而OPT组增加了+3.6 / +6.0次/分钟（P < 0.001）。1年后，INH组QRS间期增加了12±23毫秒，而OPT组增加了+32±36毫秒（P < 0.01）。与OPT组患者相比，INH组患者左心室射血分数（LVEF）增加更多（分别为+10.6±8与+2±10%；P = 0.04）。LVEF的变化与心率呈负相关，但与QRS宽度变化无关。INH组的预后和事件发生率更好。
在长期随访中，CHF和低LVEF患者的单部位心室起搏与显著的临床事件和不良预后相关。
