Multisite pacing for end-stage heart failure: Early experience
Multisite pacing for end-stage heart failure: Early experience
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DOI：
10.1111/j.1540-8159.1996.tb03218.x
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发表时间：
1996-11-01
影响因子：
1.8
通讯作者：
Mugica, J
中科院分区：
文献类型：
--
作者：
Cazeau, S;Ritter, P;Mugica, J
我们的目标是通过同步左、右室起搏改善严重充血性心力衰竭患者的血流动力学。以前的研究报道了双腔起搏在严重心力衰竭患者中的好处，房室延迟短。然而，其他作品却出现了相互矛盾的结果。右(RV)和左(LVI)收缩去同步化的有害影响已被提出。这项研究包括8名QRS增宽和终末期心力衰竭的受试者，尽管接受了最大限度的药物治疗，但他们拒绝或不符合接受心脏移植的条件。每个患者都接受了基线的有创血流动力学评估，插入了三个临时导联，以允许不同的起搏方式，包括右室心尖和流出道起搏，以及右室流出道与左心室和右室心尖与左室之间的双室起搏。根据这项基线研究的结果，修改了原有起搏器的配置或植入了新的系统，以允许双室起搏，在窦性心律患者中，双室起搏是由心房触发的。双室起搏使平均心脏指数(CI)增加了25%(从基线的1.83+/-0.3 L/分/m(2)，P&t；0.006)，平均V波减少了26%(从基线的36+/-12毫米汞柱，P<；0.004)，肺毛细血管楔压降低了17%(从基线的31+/-10毫米汞柱，P<；0.004)。术前死亡4例，术中死亡1例，3个月内死亡2例，非心脏原因死亡1例)。4名存活的患者临床上从纽约心脏协会功能IV级改善到II级。在这些幸存者中，当在随访期间关闭多部位起搏时，CI下降了25%(P<；0.007)。在终末期心力衰竭患者中，多部位起搏可能与快速和持续的血流动力学改善有关。
Our objective was to improve hemodynamics by synchronous right and left site ventricular pacing in patients with severe congestive heart failure (CE-IF). Previous studies reported a benefit of dual chamber pacing with a short AV delay in patients with severe CHF. Other works, however show contradictory results. Deleterious effects due to a desynchronization of right (RV) and left ventricular (LVI contractions have been suggested. This study included eight subjects with widened QRS and end-stage heart failure despite maximal medical therapy, who refused, or were not eligible to undergo heart transplantation. Each patient underwent a baseline, invasive hemodynamic evaluation with insertion of three temporary leads to allow different pacing configurations, including RV apex and outflow tract pacing, and biventricular pacing between the RV outflow tract and LV and RV apex and LV. According to the results of this baseline study, the configuration of preexistent pacemakers was modified or new systems were implanted to allow biventricular pacing, which, in patients with sinus rhythm, was atrial triggered. Biventricular pacing increased the mean cardiac index (CI) by 25% (from a baseline of 1.83 +/- 0.30 L/min per m(2), P < 0.006), decreased the mean V wave by 26% (from a baseline of 36 +/- 12 mmHg, P < 0.004), and decreased pulmonary capillary wedge pressure by 17% (from a baseline of 31 +/- 10 mmHg, P < 0.01). Four patients died 12 preoperatively, 1 intraoperatively, 2 within 3 months, and 1 of a noncardiac cause). The four surviving patients have clinically improved from New York Heart Association Functional Class IV to Class II. In these survivors, CI decreased by 25% (P < 0.007) when multisite pacing was turned off during follow-up. In patients with end-stage heart failure, multisite pacing may be associated with a rapid and sustained hemodynamic improvement.