Mathew V, Chaliki H, Nishimura R A
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Clin Cardiol. 1997 Aug;20(8):723-5. doi: 10.1002/clc.4960200811.
Congestive heart failure due to cardiac amyloidosis is often refractory to conventional medical management and is associated with a high mortality rate. Recently, dual-chamber pacemaker implantation has been proposed as a therapeutic option in the management of patients with certain forms of cardiomyopathy with persistent heart failure symptoms, despite optimal medical therapy. The present study evaluates the acute hemodynamic response to atrioventricular (AV) pacing in patients with cardiac amyloidosis who presented with refractory heart failure symptoms.
Three patients with medically refractory heart failure due to cardiac involvement of amyloidosis underwent a simultaneous cardiac catheterization/Doppler echocardiography study with acute AV sequential pacing at varying AV intervals.
During pacing at various AV intervals, all patients showed an increased in their filling pressures and either no change or decline in their cardiac index.
The current study demonstrates an absence of acute hemodynamic with AV sequential pacing in patients with amyloid heart disease and medically refractory heart failure symptoms.
心脏淀粉样变性所致的充血性心力衰竭通常对传统药物治疗无效，且死亡率高。最近，对于某些尽管接受了最佳药物治疗但仍有持续性心力衰竭症状的心肌病患者，双腔起搏器植入术已被提议作为一种治疗选择。本研究评估了有难治性心力衰竭症状的心脏淀粉样变性患者对房室（AV）起搏的急性血流动力学反应。
3例因淀粉样变性累及心脏而导致药物难治性心力衰竭的患者，在不同的房室间期进行了同步心脏导管插入术/多普勒超声心动图研究及急性房室顺序起搏。
在不同的房室间期起搏期间，所有患者的充盈压均升高，心脏指数无变化或下降。
本研究表明，对于患有淀粉样心脏病和药物难治性心力衰竭症状的患者，房室顺序起搏不存在急性血流动力学效应。
