Dilated cardiomyopathy following right ventricular pacing for AV block in young patients: Resolution after upgrading to biventricular pacing systems
Dilated cardiomyopathy following right ventricular pacing for AV block in young patients: Resolution after upgrading to biventricular pacing systems
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DOI：
10.1111/j.1540-8167.2006.00565.x
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发表时间：
2006-10-01
影响因子：
2.7
通讯作者：
Callahan, Patrick
中科院分区：
文献类型：
--
作者：
Moak, Jeffrey P.;Hasbani, Keren;Callahan, Patrick
介绍：已证明心脏起搏治疗（CRT）可改善老年扩张型心肌病（DCM）患者的临床症状，尤其是左束支分支传导阻滞和QRS时限延长的患者。我们试图证明心脏再同步治疗的好处，改善心脏功能和临床结果的年轻患者，发展充血性心力衰竭（CHF）和扩张型心肌病心脏起搏AV block.Methods和结果：我们审查了6例患者的图表谁开发CHF或低心输出量症状和扩张型心肌病右心室（RV）为基础的起搏系统植入AV block，随后接受心脏再同步治疗。患者年龄范围为6个月至23.7岁（平均年龄：11.3 ± 3.6岁）。房室传导阻滞为先天性（3例）、术后（2例）和获得性（1例）。在发生DCM之前，已进行了0.1-14.5（7.6 +/- 2.4）年的起搏。2例患者需要登记进行心脏移植。CRT之后：（1）QRS时限从204 +/- 15缩短至138 +/- 10 msec，P = 0.002，（2）左心室射血分数从34 +/- 6改善至60 +/-2%，P = 0.003，（3）左心室舒张末期内径从5.5 +/- 0.8缩短至4.3 +/- 0.5 cm，P =0.03。所有患者表现出临床改善，并已断奶CHF药物和上市cardiac transplantation.Conclusions：CRT可以受益于年轻患者发展CHF和DCM右心室起搏AV block。在这些患者列入心脏移植名单之前，应在早期管理中考虑升级为双心室起搏系统。
Introduction: Cardiac resynchronization therapy (CRT) has been demonstrated to result in clinical improvement in older adult patients with dilated cardiomyopathy (DCM), specifically those with left bundle branch block and prolonged QRS duration. We sought to demonstrate the benefits of CRT on improvement in cardiac function and clinical outcome in young patients that developed congestive heart failure (CHF) and DCM following cardiac pacing for AV block.Methods and Results: We reviewed the charts of six patients who developed CHF or low cardiac output symptoms and DCM following implantation of right ventricular (RV)-based pacing systems for AV block, and subsequently underwent CRT. Patients ranged in age from 6 months to 23.7 years (mean: 11.3 +/- 3.6 years). AV block was congenital (3), post-surgery (2), and acquired (1). Pacing had been performed for 0.1-14.5 (7.6 +/- 2.4) years prior to development of DCM. Two patients required listing for cardiac transplantation. Following CRT: (1) QRS duration shortened from 204 +/- 15 to 138 +/- 10 msec, P = 0.002, (2) left ventricular ejection fraction improved from 34 +/- 6 to 60 +/- 2%, P = 0.003, and (3) left ventricular end diastolic dimension shortened from 5.5 +/- 0.8 to 4.3 +/- 0.5 cm, P =0.03. All patients demonstrated clinical improvement and have been weaned from CHF medications and listing for cardiac transplantation.Conclusions: CRT can benefit young patients that develop CHF and DCM following RV pacing for AV block. Upgrading to biventricular pacing systems should be considered early in the management of these patients prior to listing for cardiac transplantation.