Physiology of biventricular pacing.
Physiology of biventricular pacing.
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DOI：
10.1007/bf02938362
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发表时间：
2007-09-01
影响因子：
3.7
通讯作者：
Kass, David A
中科院分区：
文献类型：
--
作者：
Bilchick, Kenneth C;Helm, Robert H;Kass, David A
双心室起搏（心脏再同步治疗）已被证明是治疗心力衰竭和不同步患者的一种非常有效的疗法，最近的一项试验显示其生存率有所提高。电不同步通常通过 QRS 波群的持续时间来量化，它与机械不同步不同。心室内机械不同步最常见的表现是室间隔工作减少，同时伴有早期侧壁预拉伸和随后的低效晚期收缩。心室内不同步似乎比心室间不同步更能预测 CRT 的反应。机械性左心室不同步还与连接蛋白 43、应激反应激酶和肿瘤坏死因子 α 的区域分子紊乱有关。这些分子紊乱可能导致传导速度和动作电位持续时间异常，从而导致室性心律失常。双心室起搏可纠正异常的局部壁应力并导致电、机械和分子左心室重塑。
Biventricular pacing (cardiac resynchronization therapy ) has been shown to be a very effective therapy for patients with heart failure and dyssynchrony, with improved survival now shown in a recent trial. Electrical dyssynchrony, usually quantified by the duration of the QRS complex, is distinct from mechanical dyssynchrony. Intraventricular mechanical dyssynchrony is most commonly manifest by decreased septal work with concomitant early lateral wall prestretch and subsequent inefficient late contraction. Intraventricular dyssynchrony appears to be more predictive of response to CRT than interventricular dyssynchrony. Mechanical left ventricular dyssynchrony also is associated with regional molecular derangements in connexin-43, stress response kinases, and tumor necrosis factor-alpha. These molecular derangements may lead to abnormalities in conduction velocity and action potential duration, which may predispose to ventricular arrhythmia. Biventricular pacing corrects abnormal regional wall stresses and results in electrical, mechanical, and molecular left ventricular remodeling.