USEFULNESS OF PHYSIOLOGICAL DUAL-CHAMBER PACING IN DRUG-RESISTANT IDIOPATHIC DILATED CARDIOMYOPATHY
USEFULNESS OF PHYSIOLOGICAL DUAL-CHAMBER PACING IN DRUG-RESISTANT IDIOPATHIC DILATED CARDIOMYOPATHY
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DOI：
10.1016/0002-9149(90)90588-r
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发表时间：
1990-07-15
影响因子：
2.8
通讯作者：
ZECHMANN, W
中科院分区：
文献类型：
--
作者：
HOCHLEITNER, M;HORTNAGL, H;ZECHMANN, W
对16例常规药物治疗无效的终末期特发性扩张型心肌病患者进行了生理性双腔起搏(DDD)的疗效评价。心脏移植的候选人以及未接受移植的患者参加了试验。在房室延迟100ms的DDD起搏期间，左心室射血分数从16.0±-增加。8.4至25.6。+-。8.6%(P<；0.001)伴有明显的临床症状改善，如休息时严重的呼吸困难和肺水肿。纽约心脏协会的课程从3.6.+-下降。0.4至2.1。+-。0.5%(P<；0.001)。心胸比率从0.60.+-下降。0.06至0.56.+-。0.05(p<；0.001)与左房和右室超声心动图的内径减少相吻合，表明前负荷减少。收缩压从108。+-升高。29至126。+-。21毫米汞柱(p<；0.01)，舒张压从67.+-。15至80。+-。11毫米汞(p<；0.01)。心率达到正常化。DDD起搏后未出现重大并发症。所有患者均可在起搏器植入后3周内出院，恢复正常生活。在DDD起搏开始后的一年内，只有4名患者死亡(猝死或中风)。DDD起搏可能是治疗扩张型心肌病所致慢性心力衰竭的另一种方法，特别是对于心脏移植候选人和不接受心脏移植但对药物治疗不再有效的患者。
The beneficial effects of physiologic dual-chamber (DDD) pacing in the treatment of end-stage idiopathic dilated cardiomyopathy were evaluated in 16 patients in whom conventional drug therapy had failed. Candidates for cardiac transplantation as well as patients not accepted for transplantation participated. During DDD pacing at an atrioventricular delay of 100 ms, left ventricular ejection fraction increased from 16.0 .+-. 8.4 to 25.6 .+-. 8.6% (p < 0.001) accompanied by a striking improvement in clinical symptoms, such as severe dyspnea at rest and pulmonary edema. The New York Heart Association class decreased from 3.6 .+-. 0.4 to 2.1 .+-. 0.5 (p < 0.001). The decrease in cardiothoracic ratio from 0.60 .+-. 0.06 to 0.56 .+-. 0.05 (p < 0.001) coincided with a decrease in left atrial and right ventricular echocardiographic dimensions, indicating a decrease in preload. Systolic blood pressure increased from 108 .+-. 29 to 126 .+-. 21 mm Hg (p < 0.01) and diastolic blood pressure from 67 .+-. 15 to 80 .+-. 11 mm Hg (p < 0.01). Normalization of heart rate was achieved. No major complications developed as a consequence of DDD pacing. All patients could be discharged from the hospital within 3 weeks after pacemaker implantation and return to a relatively normal life. Within 1 year after onset of DDD pacing only 4 of the patients died (from either sudden death or stroke). DDD pacing could represent an alternative approach to the management of chronic heart failure due to dilated cardiomyopathy, especially for heart transplant candidates and patients who are not accepted for cardiac transplantation, but no longer respond to drug therapy.