Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, China.
Chin Med J (Engl). 2010 Sep;123(17):2295-8.
Cardiac resynchronization therapy (CRT) could improve heart function, symptom status, quality of life and reduce hospitalization and mortality in patients with severe heart failure (HF) with optimal medical management. However, the possible adverse effects of CRT are often ignored by clinicians.
A retrospective analysis of CRT over a 6-year period was made in a single cardiac center.
Fifty-four patients were treated with CRT(D) device, aged (57 ± 11) years, with left ventricular ejection fraction of (32.1 ± 9.8)%, of which 4 (7%) developed ventricular tachycardia/ventricular fibrillation (VT/VF) or junctional tachycardia after operation. Except for one with frequent ventricular premature beat before operation, the others had no previous history of ventricular arrhythmia. Of the 4 patients, 3 had dilated cardiomyopathy and 1 had ischemic cardiomyopathy, and tachycardia occurred within 3 days after operation. Sustained, refractory VT and subsequent VF occurred in one patient, frequent nonsustained VT in two patients and nonparoxysmal atrioventricular junctional tachycardia in one patient. VT was managed by amiodarone in two patients, amiodarone together with beta-blocker in one patient, and junctional tachycardia was terminated by overdrive pacing. During over 12-month follow-up, except for one patient's death due to refractory heart and respiratory failure in hospital, the others remain alive and arrhythmia-free.
New-onset VT/VF or junctional tachycardia may occur in a minority of patients with or without prior history of tachycardia after biventricular pacing. Arrhythmia can be managed by conventional therapy, but may require temporary discontinuation of pacing. More observational studies should be performed to determine the potential proarrhythmic effect of CRT.
心脏再同步治疗（CRT）可改善严重心力衰竭（HF）患者的心脏功能、症状状态、生活质量，并降低住院率和死亡率，前提是这些患者接受了最佳的药物治疗。然而，临床医生往往忽略 CRT 的可能不良反应。
在一家心脏中心对 CRT 进行了为期 6 年的回顾性分析。
54 例患者接受了 CRT（D）装置治疗，年龄（57 ± 11）岁，左心室射血分数（32.1 ± 9.8）%，其中 4 例（7%）术后发生室性心动过速/心室颤动（VT/VF）或交界性心动过速。除 1 例术前频发室性早搏外，其余患者均无室性心律失常既往史。4 例患者中，3 例为扩张型心肌病，1 例为缺血性心肌病，心动过速发生在术后 3 天内。1 例患者持续、难治性 VT 后发生 VF，2 例患者频发非持续 VT，1 例患者发生非阵发性房室交界区心动过速。2 例患者使用胺碘酮治疗 VT，1 例患者胺碘酮联合β受体阻滞剂治疗，1 例患者通过超速起搏终止交界性心动过速。在 12 个月的随访中，除 1 例患者因院内难治性心肺衰竭死亡外，其余患者均存活且无心律失常。
在有或无心动过速既往史的患者中，双心室起搏后少数患者可能会新发 VT/VF 或交界性心动过速。心律失常可通过常规治疗进行管理，但可能需要暂时停止起搏。应开展更多的观察性研究以确定 CRT 的潜在致心律失常作用。
