Scanu P, Lecluse E, Michel L, Bureau G, Saloux E, Cleron S, Valette B, Grollier G, Potier J C, Foucault J P
Service de cardiologie, CHU de Caen.
Arch Mal Coeur Vaiss. 1996 Dec;89(12):1643-9.
The authors studied 18 patients (15 men, 3 women) with an average age of 67 +/- 8 years with refractory cardiac failure. In order to determine the potential of pacing to raise cardiac output in severe cardiac failure. The average ejection fraction was 26 +/- 6.5%. All patients were in sinus rhythm:resting cardiac output was 3.35 l/min. Two temporary pacing catheters were positioned in the right atrium and at the apex of the right ventricle for dual-chamber mode pacing triggered by the spontaneous P waves. Changes in cardiac output were measured by Doppler echocardiography at different values of atrioventricular delay. Patients were considered to be responders if their cardiac outputs rose by 15%. In 7 patients meeting this criterion, the average increase in cardiac output was 27% (2.99 +/- 0.7 to 3.81 +/- 0.86 l/mn; p < 0.01); all had dilated cardiomyopathies with left bundle branch block and the optimal AV delay was 103 +/- 21 ms (80-140 ms); the duration of diastolic filling increased from 212 +/- 98 to 292 +/- 116 ms (p = 0.02). In the non-responding group (11 patients with an increase of cardiac output of only 3.6 +/- 0.09 to 3.9 +/- 0.92 l/mn; p < 0.01), the underlying disease process was mainly ischaemic. Two predictive factors of efficacy of dual-chamber pacing were identified: a short ventricular filling period (29 +/- 8% of the RR interval in the responders vs 44 +/- 9% in the non-responders; p < 0.01) and the presence of 1st degree atrioventricular block. Dual-chamber pacing could be a valuable method of increasing resting cardiac outputs in a selected group of patients with severe, refractory, cardiac failure.
作者研究了18例（15例男性，3例女性）平均年龄为67±8岁的难治性心力衰竭患者。目的是确定起搏在严重心力衰竭中提高心输出量的潜力。平均射血分数为26±6.5%。所有患者均为窦性心律：静息心输出量为3.35升/分钟。两根临时起搏导管分别置于右心房和右心室心尖处以进行由自发P波触发的双腔起搏模式。通过多普勒超声心动图在不同房室延迟值下测量心输出量的变化。如果患者的心输出量增加15%，则被视为反应者。在7例符合该标准的患者中，心输出量平均增加27%（从2.99±0.7升至3.81±0.86升/分钟；p<0.01）；所有患者均患有扩张型心肌病并伴有左束支传导阻滞，最佳房室延迟为103±21毫秒（80 - 140毫秒）；舒张期充盈时间从212±98毫秒增加到292±116毫秒（p = 0.02）。在无反应组（11例患者，心输出量仅从3.6±0.09升至3.9±0.92升/分钟；p<0.01）中，潜在疾病过程主要为缺血性。确定了双腔起搏疗效的两个预测因素：短心室充盈期（反应者的RR间期的29±8%，无反应者为44±9%；p<0.01）和一度房室传导阻滞的存在。双腔起搏可能是增加特定严重、难治性心力衰竭患者静息心输出量的一种有价值的方法。
