Heart Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Physiol Res. 2011;60(6):877-85. doi: 10.33549/physiolres.932060. Epub 2011 Oct 12.
Cardiac resynchronization therapy is not commonly used in the early postoperative period in patients undergoing cardiac surgery who have left ventricular (LV) dysfunction and a history of heart failure. We performed a prospective randomized clinical trial to compare atrial synchronous right ventricular (DDD RV) and biventricular (DDD BIV) pacing within 72 hours after cardiac surgery in patients with an EF ≤35 %, a QRS interval longer than 120 msec and who had LV dyssynchrony detected by real-time three-dimensional echocardiography (RT3DE). Epicardial pacing was provided by a modified Medtronic INSYNC III pacemaker. An LV epicardial pacing lead was implanted on the latest activated segment of the LV based on RT3DE. The study included 18 patients with ischemic heart disease, with or without valvular heart disease (14 men, 4 women, average age 71 years). Patients undergoing DDD BIV pacing had a statistically significant greater CO and CI (CO 6.7±1.8 l/min, CI 3.4±0.7 l/min/m(2)) than patients undergoing DDD RV pacing (CO 5.5±1.4 l/min, CI 2.8±0.7 l/min/m(2)), p<0.001. DDD BIV pacing in the early postoperative period after cardiac surgery corrects LV dyssynchrony and has better hemodynamic results than DDD RV pacing.
心脏再同步治疗在心脏手术后左心室（LV）功能障碍和心力衰竭病史的患者的早期术后阶段并不常用。我们进行了一项前瞻性随机临床试验，比较了心脏手术后 72 小时内 EF ≤35％、QRS 间隔大于 120 毫秒且通过实时三维超声心动图（RT3DE）检测到 LV 不同步的患者的心房同步右心室（DDD RV）和双心室（DDD BIV）起搏。心外膜起搏由改良的美敦力 INSYNC III 起搏器提供。根据 RT3DE，在 LV 的最新激活节段上植入 LV 心外膜起搏导线。该研究包括 18 例缺血性心脏病患者，伴或不伴瓣膜性心脏病（男性 14 例，女性 4 例，平均年龄 71 岁）。接受 DDD BIV 起搏的患者 CO 和 CI（CO 6.7±1.8 l/min，CI 3.4±0.7 l/min/m(2)）明显大于接受 DDD RV 起搏的患者（CO 5.5±1.4 l/min，CI 2.8±0.7 l/min/m(2)），p<0.001。心脏手术后早期接受 DDD BIV 起搏可纠正 LV 不同步，与 DDD RV 起搏相比具有更好的血液动力学结果。
