4-CHAMBER PACING IN DILATED CARDIOMYOPATHY
4-CHAMBER PACING IN DILATED CARDIOMYOPATHY
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DOI：
10.1111/j.1540-8159.1994.tb03783.x
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发表时间：
1994-11-01
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
1例54岁男性患者接受了四腔起搏系统治疗严重充血性心力衰竭(NYHA功能IV级)。他的心电图显示左束支传导阻滞(QRS持续时间200毫秒)，PR间期200毫秒，QRS电轴正常，房间隔90毫秒。在植入前进行了四个临时导联的急性血流动力学研究，结果显示心输出量显著增加，肺毛细血管楔压显著降低。根据这项急性研究令人鼓舞的结果，植入了永久起搏器。右室导联采用头颅和锁骨下入路。左心房用美敦力SP2188-58型冠状静脉窦电极起搏。心外膜美敦力5071导联置于LV游离壁。这四根导线连接到标准的双极DDD起搏器Chorus 6234上。两个心房导线通过Y形连接器连接到起搏器的心房通道，起搏配置为双极起搏。两个脑室导联以类似的方式连接到该装置的脑室通道。右室导联与远端电极相连。左房电极与起搏器近端电极相连。6周后，患者临床症状明显改善，体重减轻17公斤，周围水肿消失。他的功能级别降到了NYHA II级，四腔起搏在技术上是可行的。在有室间不同步证据的患者中，这种原始的起搏模式可能提供了一种更接近自然状态的机械激活序列。我们怀疑这项技术是否会对长期生存产生影响，但它可能对改善患者的福祉和控制心力衰竭具有重要意义。
A 54-year-old man received a four chamber pacing system for severe congestive heart failure (NYHA functional Class IV). His ECG showed a left bundle branch block (200-msec QRS duration) with 200-msec PR interval, normal QRS axis, and 90-msec interatrial interval. An acute hemodynamic study with insertion of four temporary leads was performed prior to the implant, which demonstrated a significant increase in cardiac output and decrease of pulmonary capillary wedge pressure. A permanent pacemaker was implanted based on the encouraging results of the acute study. The right chamber leads were introduced by cephalic and subclavian approaches. The left atrium was paced with a coronary sinus lead, Medtronic SP 2188-58 model. An epicardial Medtronic 5071 lead was placed on the LV free wall. The four leads were connected to a standard bipolar DDD pacemaker, Chorus 6234. The two atrial leads were connected via a Y-connector to the atrial channel of the pacemaker with a bipolar pacing configuration. The two ventricular leads were connected in a similar fashion to the ventricular channel of the device. The right chamber leads were connected to the distal poles. The left chamber leads were connected to the proximal poles of the pacemaker. Six weeks later, the patient's clinical status improved markedly with a weight loss of 17 kg and disappearance of peripheral edema. His functional class was reduced to NYHA II, Four chamber pacing is technically feasible. In patients with evidence of interventricular dyssynchrony, this original pacing mode probably provides a mechanical activation sequence closer to the natural one. We doubt that this technique will have an impact on long-term survival, but it could be of major importance to improve the patient's well-being and control heart failure.