Right ventricular pacing can induce ventricular dyssynchrony in patients with atrial fibrillation after atrioventricular node ablation
Right ventricular pacing can induce ventricular dyssynchrony in patients with atrial fibrillation after atrioventricular node ablation
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DOI：
10.1016/j.jacc.2006.05.072
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发表时间：
2006-10-17
影响因子：
24
通讯作者：
Bax, Jeroen J.
中科院分区：
文献类型：
--
作者：
Tops, Laurens F.;Schalij, Martin J.;Bax, Jeroen J.
目的：本研究旨在评估长期右心室（RV）起搏对左室（LV）非同步化、左室功能和心力衰竭症状的影响。房室（AV）结消融和随后的长期RV起搏是房颤（AF）患者公认的治疗选择。方法对55例药物难治性房颤患者行房室结消融和心脏起搏器植入。在基线和平均3.8±1.7年之后，评估左室不同步（通过m型超声心动图和组织多普勒成像）、左室功能、容积和功能状态。结果长期左室起搏后，27例（49%）患者发生左室非同步化。同时，这些患者心衰症状加重（纽约心脏协会功能分级从1.8 +/- 0.6增加到2.2 +/- 0.7,p < 0.05），左室射血分数降低（从48 +/- 7%增加到43 +/- 7%，p < 0.05），左室舒张末期容积增加（从116 +/- 39 ml增加到130 +/- 52 ml， p < 0.05）。相反，没有左室非同步化的患者在心衰症状、左室功能或左室容积方面没有恶化。结论：在近50%接受房室结消融治疗的慢性房颤患者中，长期RV起搏可诱发左室非同步化。左室非同步化的发展与心衰症状、左室收缩功能和左室扩张恶化有关。
OBJECTIVES This study was designed to assess the effects of long-term right ventricular (RV) pacing on left ventricular (LV) dyssynchrony, LV function, and heart failure symptoms.BACKGROUND Atrioventricular (AV) node ablation and subsequent long-term RV pacing is a well-established treatment option in patients with atrial fibrillation (AF).METHODS In 55 patients with drug-refractory AF, AV node ablation and implantation of a pacemaker was performed. At baseline and after a mean of 3.8 +/- 1.7 years, LV dyssynchrony (by M-mode echocardiography and tissue Doppler imaging), LV function, and volumes and functional status were assessed.RESULTS After long-term RV pacing, 27 patients (49%) had developed LV dyssynchrony. Concomitantly, these patients worsened in heart failure symptoms (New York Heart Association functional class increased from 1.8 +/- 0.6 to 2.2 +/- 0.7, p < 0.05), with a decrease in LV ejection fraction (from 48 +/- 7% to 43 +/- 7%, p < 0.05) and an increase in LV end-diastolic volume (from 116 +/- 39 ml to 130 +/- 52 ml, p < 0.05). Conversely, patients without LV dyssynchrony did not deteriorate in heart failure symptoms, LV function, or LV volumes.CONCLUSIONS Long-term RV pacing can induce LV dyssynchrony in almost 50% of patients treated with AV node ablation for chronic AF. The development of LV dyssynchrony was associated with deterioration in heart failure symptoms, systolic LV function, and LV dilatation.