Duran Nilüfer Ekşi, Astarcioğlu Mehmet Ali, Aykan Ahmet Cağri, Karapinar Hekim, Duran Ibrahim, Ertürk Emre, Gökdeniz Tayyar, Kaya Hasan, Ozkan Mehmet
Department of Cardiology, Kartal Koşuyolu Heart and Research Hospital, Istanbul, Turkey.
Turk Kardiyol Dern Ars. 2009 Mar;37(2):107-11.
Stabilization of the cardiovascular system is maintained by variations in hemodynamic and hormonal parameters in complete atrioventricular (AV) block. We investigated the variations in hemodynamic parameters and brain natriuretic peptide (BNP) levels before and after permanent pacemaker implantation for complete AV block.
We evaluated 25 patients (14 men, 11 women; mean age 72+/-10 years; range 39 to 83 years) who presented with a complaint of syncope due to complete AV block. All the patients were hemodynamically stable on presentation and were monitored in the coronary care unit until permanent pacemaker implantation. Variations in the cardiovascular system were determined before and two weeks after pacemaker implantation, including mean arterial pressure (MAP), stroke volume (SV), cardiac output (CO), systemic vascular resistance (SVR), systemic aortic compliance (SAC), and BNP levels.
The mean heart rates were 36+/-6 beat/min and 65+/-10 beat/min before and after pacing, respectively. Compared to the pacing period, CO was significantly lower (p<0.001) and SVR was significantly higher (p=0.001) before pacemaker implantation, suggesting a compensatory rise in SVR. The mean arterial pressure did not show a significant difference and remained within normal ranges before and after pacing. There were no significant differences in SV, SAC, and BNP levels before and after pacemaker implantation, with BNP exhibiting increased levels in both periods.
While no compensatory alterations occur in SV, SAC, and BNP before and after pacemaker implantation, decreased CO in complete AV block seems to be balanced by increased SVR, which results in maintenance of MAP within the normal range.
在完全性房室传导阻滞中，心血管系统的稳定通过血流动力学和激素参数的变化来维持。我们研究了永久性起搏器植入前后完全性房室传导阻滞患者血流动力学参数和脑钠肽（BNP）水平的变化。
我们评估了25例因完全性房室传导阻滞而出现晕厥症状的患者（14例男性，11例女性；平均年龄72±10岁；范围39至83岁）。所有患者就诊时血流动力学稳定，并在冠心病监护病房接受监测直至永久性起搏器植入。在起搏器植入前和植入后两周测定心血管系统的变化，包括平均动脉压（MAP）、每搏输出量（SV）、心输出量（CO）、全身血管阻力（SVR）、全身主动脉顺应性（SAC）和BNP水平。
起搏前后平均心率分别为36±6次/分钟和65±10次/分钟。与起搏期相比，起搏器植入前CO显著降低（p<0.001），SVR显著升高（p=0.001），提示SVR代偿性升高。平均动脉压在起搏前后无显著差异，且均保持在正常范围内。起搏器植入前后SV、SAC和BNP水平无显著差异，BNP在两个时期均呈升高趋势。
虽然起搏器植入前后SV、SAC和BNP没有发生代偿性改变，但完全性房室传导阻滞中CO的降低似乎通过SVR的升高得到平衡，从而使MAP维持在正常范围内。
