Department of Cardiovascular Science and Medicine, Chiba University, Chiba, Japan.
Europace. 2011 Feb;13(2):230-6. doi: 10.1093/europace/euq443. Epub 2010 Dec 22.
Long-standing right ventricular apical pacing (RVAP) may result in impaired left ventricular (LV) function and systolic heart failure (HF) in selected patients. However, which patients are susceptible to those harmful effects is unknown.
In 367 consecutive patients undergoing pacemaker implantations (PMIs) and RVAP, the clinical, laboratory, and echocardiographic data before the PMIs, electrocardiographic parameters [baseline and paced QRS duration (QRSd)], and echocardiography were analysed. The cumulative per cent of those ventricularly paced (Cum%VP) was >90% in all subjects. During a mean follow-up period of 113±69 months, the occurrence of HF requiring hospitalization for the intravenous administration of HF medications was found in 60 patients (16%; HF group), but not in the remaining 307 (84%; no-HF group). The prevalence of structural heart disease (SHD; P<0.0001), cardiothoracic ratio (P<0.0001), baseline left atrial size (P=0.0001), LV end-diastolic volume (P<0.005) and end-systolic volume (P<0.0005), LV mass index (P<0.001), and baseline and paced QRSd (both for P<0.001) were greater in the HF group than in the no-HF group. Inversely, the LV ejection fraction (LVEF) in the HF group was smaller than that in the no-HF group (P<0.001). The multivariate Cox regression analysis revealed that the presence of SHD [hazard ratio (HR)=3.12; 95% confidence interval (CI), 1.7-5.7; P<0.001] and the LVEF (<40%; HR=2.57; 95% CI, 1.09-6.07; P<0.05) were associated with hospitalizations due to HF after RVAP.
The presence of SHD and an impaired LV systolic function before the PMI may predict hospitalizations due to HF after RVAP.
长期右心室心尖部起搏（RVAP）可能导致部分患者左心室（LV）功能受损和收缩性心力衰竭（HF）。然而，哪些患者容易受到这些不良影响尚不清楚。
在 367 例连续接受起搏器植入（PMIs）和 RVAP 的患者中，分析了植入前的临床、实验室和超声心动图数据、心电图参数（基线和起搏 QRS 持续时间[QRSd]）和超声心动图。所有患者的心室起搏累积百分比（Cum%VP）均>90%。在平均 113±69 个月的随访期间，发现 60 例（16%；HF 组）需要住院接受 HF 药物静脉治疗的 HF 患者，但剩余的 307 例（84%；无 HF 组）没有发生。结构性心脏病（SHD；P<0.0001）、心胸比（P<0.0001）、左心房大小的基线值（P=0.0001）、LV 舒张末期容积（P<0.005）和收缩末期容积（P<0.0005）、LV 质量指数（P<0.001）以及基线和起搏 QRSd（均 P<0.001）在 HF 组中均大于无 HF 组。相反，HF 组的 LV 射血分数（LVEF）小于无 HF 组（P<0.001）。多变量 Cox 回归分析显示，SHD 的存在（危险比[HR]=3.12；95%置信区间[CI]，1.7-5.7；P<0.001）和 LVEF（<40%；HR=2.57；95%CI，1.09-6.07；P<0.05）与 RVAP 后因 HF 住院相关。
PMI 前存在 SHD 和 LV 收缩功能障碍可能预测 RVAP 后因 HF 住院。
