Kappenberger L, Aebischer N, Jeanrenaud X
Division de Cardiologie, CHUV, Lausanne, Suisse.
Ann Cardiol Angeiol (Paris). 1994 Dec;43(10):573-7.
Up until recently, the first-line treatment of obstructive hypertrophic cardiomyopathy was pharmacological and surgical in refractory cases. However, the immediate beneficial effect of a cardiac pacing on infra-aortic obstruction has been known for many years. The development of sophisticated two-chamber pacemakers and their use in patients with obstructive hypertrophic cardiomyopathy has confirmed their beneficial effect both in terms of haemodynamic and clinical parameters. There appears to be many reasons for this advantageous effect and only some of them have been elucidated, including alteration of the activation sequence of the left ventricle secondary to apical ectopic electrical activation and reduction of the contact time of the mitral valve with the proximal septum and, in the long term, ventricular remodelling secondary to release of the outflow obstruction. The increasing number of publications reporting a beneficial effect of two-chamber pacemakers in these patients justifies consideration of this approach in all patients refractory to drug therapy.
直到最近，梗阻性肥厚型心肌病的一线治疗方法在难治性病例中还是药物治疗和手术治疗。然而，心脏起搏对主动脉下梗阻的即时有益作用已为人所知多年。先进的双腔起搏器的研发及其在梗阻性肥厚型心肌病患者中的应用，已证实其在血流动力学和临床参数方面均具有有益作用。这种有利作用的原因似乎有很多，其中只有一些已得到阐明，包括由于心尖异位电激活导致左心室激活顺序改变，以及二尖瓣与近端室间隔接触时间缩短，从长期来看，还包括由于流出道梗阻解除导致的心室重塑。越来越多的出版物报道双腔起搏器对这些患者具有有益作用，这使得在所有药物治疗无效的患者中考虑这种治疗方法是合理的。
