Estimulaçao Elétrica na Insuficiência Cardíaca. Marcapasso Ventricular Direito Bifocal
Estimulaçao Elétrica na Insuficiência Cardíaca. Marcapasso Ventricular Direito Bifocal
复制标题
Estimulação Elétrica na Insuficiência Cardíaca（马尔卡帕索心室直接双焦）
DOI：
--
复制
发表时间：
2000
期刊：
影响因子：
--
通讯作者：
Gimenes Vm
中科院分区：
文献类型：
--
作者：
José Carlos Pachón Mateos;J. Mateos;R. N. Albornoz;E. I. P. Mateos;Gimenes Vm
除了调整心率外，起搏在充血性心力衰竭和严重心肌病中也有新的应用。在无心动过缓的心力衰竭患者中，心室刺激可能适用于宽QRS患者（左束分支传导阻滞或右心室内膜起搏）。在这些情况下，双心室刺激（通过冠状窦或心外膜入路，一根电极导线在右心室，另一根在左心室）可将心脏指数从15%提高到25%，这是一种公认且可接受的起搏器适应症。然而，我们已经观察到，使用一个心尖电极导线和一个高间隔电极导线（心室内起搏）的右心室内膜双焦刺激也可以使心脏指数从10%增加到25%，二尖瓣返流和左心房面积显著减少，而不会造成开胸手术或冠状窦刺激的不便。我们已经发现，这种刺激引起良好的收缩和显著的舒张改善。因此，在接下来的几年里，我们肯定会在电极导线和起搏器方面取得巨大进展，从而使多部位心脏起搏能够彻底用于治疗和预防心力衰竭。起搏器、多部位起搏、充血性心力衰竭。Reblampa 78024 - 282参考文献NCIAS BIBLIOGRAFICAS 1 Stellbrink C，Auricchio A，Diem B，et al.充血性心力衰竭和室性快速性心律失常患者双心室起搏的潜在受益。美国心脏病学杂志1999; 83（5B）。2肖HB，布雷克SJ，吉布森DG。异常激动对扩张型心肌病左室压力脉冲时程的影响。英国心脏杂志1992; 68（4）：403 - 7。3肖HB，李CH，吉布森DG.左束支分支阻滞对扩张型心肌病舒张功能的影响Br Heart J 1991; 66（6）：443 - 7. 4肖HB，吉布森DG。间歇性左束支分支传导阻滞对左室舒张功能影响1例。国际心脏病学杂志1994; 46（1）：85 - 8. 5张文，王文，等.四腔起搏治疗扩张型心肌病的临床研究.中华心血管病杂志，2000，24（1）：119 - 119. PACE 1994; 17（11）：1974 - 9。
Besides adjusting heart rate, there has been new applications for pacing in congestive heart failure and severe cardiomyopathy. In heart failure even without bradycardia, ventricular stimulation maybe suitable for wide QRS patients (left bundle branch block or right ventricular endocardial pacing). In these cases, biventricular stimulation (one lead in the RV and the other in the LV by the coronary sinus or epicardial approach) can improve the cardiac index from 15 up to 25%, being a well established and accepted pacemaker indication. However, we have observed that right ventricular endocardial bifocal stimulation, with one apex lead and one high septum lead (intraventricular resynchronization), can also increase the cardiac index from 10 to 25% with important reduction in the mitral regurgitation and left atrium area without the inconvenience of the thoracotomy or the stimulation by the coronary sinus. We have found that this stimulation causes good systolic and remarkable diastolic improvements. Hence, in the next years we will certainly have great progresses in leads and pacemakers allowing multi-site cardiac pacing to be used thoroughly, in treatment and prevention of heart failure. DESCRIPTORS: pacemaker, multi-site pacing, congestive heart failure. Reblampa 78024-282 REFERÊNCIAS BIBLIOGRÁFICAS 1 Stellbrink C, Auricchio A, Diem B, et al. Potential benefit of biventricular pacing in patients with congestive heart failure and ventricular tachyarrhythmias. Am J Cardiol 1999; 83(5B). 2 Xiao HB, Brecker SJ, Gibson DG. Effects of abnormal activation on the time course of the left ventricular pressure pulse in dilated cardiomyopathy. Br Heart J 1992; 68(4): 403-7. 3 Xiao HB, Lee CH, Gibson DG. Effect of left bundle branch block on diastolic function in dilated cardiomyopathy Br Heart J 1991; 66(6): 443-7. 4 Xiao HB, Gibson DG. Effects of intermittent left bundle branch block on left ventricular diastolic function: a case report. Int J Cardiol 1994; 46(1): 85-8. 5 Cazeau S, Ritter P, Bakdach S, et al. Four chamber pacing in dilated cardiomyopathy. PACE 1994; 17(11): 1974-9.