Hemodynamic effects of acute atrioventricular sequential pacing in patients with left ventricular dysfunction.
Hemodynamic effects of acute atrioventricular sequential pacing in patients with left ventricular dysfunction.
复制标题
急性房室序贯起搏对左心室功能障碍患者的血流动力学影响。
DOI：
10.1016/0002-9149(82)91947-6
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发表时间：
1982
期刊：
影响因子：
--
通讯作者：
Hindman,MC
中科院分区：
文献类型：
--
作者：
Reiter,MJ;Hindman,MC
对7例有症状性左心衰(纽约心脏协会功能分级为III级和IV级)且左心室射血分数降低(平均29%，范围18~40)的男性患者进行了急性房室(A-V)序贯起搏和心室起搏的比较。起搏频率为75~100次/min时，A-V顺序起搏时的心脏指数均高于室性起搏时。起搏速度为75次/分钟时，平均增加17%(10~37次)，起搏速度为85次/分钟时，平均增加23%(范围8~45次)，起搏速度为100次/分钟时，平均增加29%(范围19~55次)。单个患者心脏指数的增加与基线指标(包括功能分级、心胸比率、静息射血分数、心脏指数或球囊阻塞的肺楔压)无关。起搏期间动脉压因房室收缩关系的变化而变化。当心房收缩先于室性起搏一段生理间隔时，动脉内脉压均匀增加。这一增加与房室顺序起搏期间心脏指数的增加密切相关(r=0.993)。在房室分离期间测量脉压是一种简单的技术，对于预测恢复房室同步的起搏方法预期的心输出量改善程度可能是有用的。
Acute atrioventricular (A-V) sequential pacing was compared with ventricular pacing in seven men with symptomatic left ventricular failure (New York Heart Association functional class III and IV) and depressed left ventricular ejection fraction (mean 29 percent, range 18 to 40). Cardiac index was higher during A-V sequential pacing than during ventricular pacing for every patient at paced rates of 75 to 100 beats/min. The mean increment was 17 percent (range 10 to 37) at a paced rate of 75 beats/ min, 23 percent (range 8 to 45) at a paced rate of 85 beats/min and 29 percent (range 19 to 55) at a paced rate of 100 beats/min. The increase in cardiac index in an individual patient did not correlate with baseline characteristics including functional class, cardiothoracic ratio, resting ejection fraction, cardiac index or balloon-occluded pulmonary wedge pressure.Arterial pressure varied from beat to beat during ventricular pacing because of the changing relation of atrial to ventricular systole. When an atrial contraction preceded a ventricular paced beat by a physiologic interval intraarterial pulse pressure uniformly increased. That increase correlated strongly (r = 0.993) with the increase in cardiac index that occurred during A-V sequential pacing. Measurement of the pulse pressure during A-V dissociation is a simple technique that may be useful for predicting the degree of improvement in cardiac output expected with methods of pacing that restore A-V synchrony.