射血分数降低的永久性心房颤动合并心力衰竭患者的最佳管理——永久性希氏束起搏是一种解决方案。病例报告。

The optimal management of patient with permanent atrial fibrillation and heart failure with reduced ejection fraction - The permanent His-bundle pacing is a solution. A case report.

作者信息

Skonieczny Bartosz, Gajek Aleksandra, Strózik Piotr, Zawadzki Jacek, Adamowicz Jakub, Gajek Jacek, Sławuta Agnieszka

机构信息

Students' Scientific Association, Wroclaw Medical University, Department of Clinical Nursing, Wroclaw, Poland.

出版信息

J Electrocardiol. 2018 Nov-Dec;51(6):1141-1144. doi: 10.1016/j.jelectrocard.2018.10.091. Epub 2018 Oct 16.

DOI:10.1016/j.jelectrocard.2018.10.091

PMID:30497746

Abstract

Atrial fibrillation (AF) coexists frequently with heart failure (HF). Permanent His-bundle pacing (pHBP) seems to be an optimal approach to the management of patients with HF and concomitant AF, which are the indication for single chamber ICD implantation. This management allows to up-titrate the beta-blocker dose in order to prevent tachyarrhythmia with no risk of bradyarrhythmia or triggering deleterious right ventricular pacing. We present a case of 69-years-old male with AF, worsening HF and high burden of RV pacing. The upgrade from single chamber ICD to dual chamber ICD with pHBP alleviated the symptoms and contributed to substantial echocardiographic improvement.

摘要

心房颤动（AF）常与心力衰竭（HF）并存。永久性希氏束起搏（pHBP）似乎是治疗HF合并AF患者的最佳方法，而这些患者是单腔植入式心律转复除颤器（ICD）植入的适应证。这种治疗方法能够增加β受体阻滞剂的剂量，以预防快速性心律失常，而不会有缓慢性心律失常的风险或引发有害的右心室起搏。我们报告一例69岁男性患者，患有AF、HF病情恶化且右心室起搏负担重。从单腔ICD升级为具有pHBP功能的双腔ICD缓解了症状，并使超声心动图有显著改善。