Caritas St Elizabeth's Medical Center, 736 Cambridge St., Boston, MA 02135, USA.
Am Heart J. 2010 Feb;159(2):264-70. doi: 10.1016/j.ahj.2009.11.012.
Randomized trials have demonstrated benefits of biventricular (BiV) pacing in patients with advanced heart failure, intraventricular conduction delay, and atrial fibrillation (AF) post-atrioventricular (AV) node ablation. The AV Node Ablation with CLS and CRT Pacing Therapies for Treatment of AF trial (AVAIL CLS/CRT) was designed to demonstrate superiority of BiV pacing in patients with AF after AV node ablation, to evaluate its effects on cardiac structure and function, and to investigate additional benefits of Closed Loop Stimulation (CLS) (BIOTRONIK, Berlin, Germany).
Patients with refractory AF underwent AV node ablation and were randomized (2:2:1) to BiV pacing with CLS, BiV pacing with accelerometer, or right ventricular (RV) pacing. Echocardiography was performed at baseline and 6 months, with paired data available for 108 patients.
The RV pacing contributed to significant increase in left atrial volume, left ventricular (LV) end-systolic volume, and LV mass compared to BiV pacing. Ejection fraction decreased insignificantly with RV pacing compared to significant increase with BiV pacing. Interventricular dyssynchrony significantly decreased with BiV compared with RV pacing. Closed Loop Stimulation did not result in additional echocardiographic changes; heart rate distribution was significantly wider with CLS. All groups showed significant improvement in 6-minute walk distance, quality-of-life score, and New York Heart Association class.
In conclusion, RV pacing results in significant increase in left atrial volume, LV mass, and worsening of LV contractility compared to patients receiving BiV pacing post-AV node ablation for refractory AF. Closed Loop Stimulation was not associated with additional structural changes but resulted in significantly wider heart rate distribution.
随机试验已经证明了双心室（BiV）起搏在患有晚期心力衰竭、室内传导延迟和房室（AV）结消融后的心房颤动（AF）患者中的益处。AV 结消融加 CLS 和 CRT 起搏治疗 AF 试验（AVAIL CLS/CRT）旨在证明 AV 结消融后 AF 患者中 BiV 起搏的优越性，评估其对心脏结构和功能的影响，并研究闭环刺激（CLS）的附加益处（BIOTRONIK，柏林，德国）。
患有难治性 AF 的患者接受 AV 结消融，并按（2:2:1）比例随机分为 BiV 起搏加 CLS、BiV 起搏加加速度计或右心室（RV）起搏。基线和 6 个月时进行超声心动图检查，108 例患者可提供配对数据。
与 BiV 起搏相比，RV 起搏导致左心房容积、左心室（LV）收缩末期容积和 LV 质量显著增加。与 BiV 起搏相比，RV 起搏导致射血分数下降不明显，但显著增加。与 RV 起搏相比，BiV 起搏导致室间不同步显著减少。CLS 并未导致额外的超声心动图变化；CLS 时心率分布明显变宽。所有组的 6 分钟步行距离、生活质量评分和纽约心脏协会（NYHA）分级均有显著改善。
总之，与 AV 结消融后接受 BiV 起搏治疗难治性 AF 的患者相比，RV 起搏导致左心房容积、LV 质量增加和 LV 收缩力恶化。CLS 与额外的结构变化无关，但导致心率分布明显变宽。
