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长期随访病窦综合征患者单腔心房或单腔心室起搏后心衰与超声心动图变化(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2002年第6期
页码:
515-517
栏目:
论著
出版日期:
2002-11-01

文章信息/Info

Title:
Heart failure and echocardiographic changes during long-term follow-up of patients with sick sinus syndrome implantated to single-chamber atrial or ventricular pacing
作者:
张 清; 王海昌; 张殿新; 李 媛; 王小燕
第四军医大学西京医院心血管内科,陕西西安710032
Author(s):
ZHANG Qing; WANG Hai-chang; ZHANG Dian-xin; LI Yuan; WANG Xiao-yan
Department of Cardiology, Xijing Hospital, Fourth Miliary Medical University, Xi' an, Shaanxi 710032, China
关键词:
病窦综合征; 起搏; 心力衰竭; 超声心动描记术
Keywords:
sick sinus syndrome;  pacing;  heart failure;  echocardiography
分类号:
R541.74
DOI:
-
文献标识码:
A
摘要:
目的 了解病态窦房结综合征(病窦)患者选择不同起搏方式和心力衰竭(心衰)发生与发展的关系。方法 165例病窦患者,分为单腔心房起搏(AAI,n=72),单腔心室起搏(VVI,n=93),在植入起搏器后3个月,以后每年1次,了解心功能(纽约心脏学学会分级标准,NYHA)、服药情况及超声心动图的变化。随访期5~8年(5.5±2.1年)。结果 在随访期VVI组93例患者有35例心衰加重,而AAI组72例患者中仅8例加重(P<0.01);VVI组利尿剂(速尿)用量高于AAI组(分别为24±38vs8±41 mg/d,P<0.01);左心室射血分数(LVEF)在VVI组明显降低(由0.42±0.12降至0.34±0.08,P<0.01),而AAI组无变化(0.40±0.13至0.38±0.09,P>0.05);左心房直径两组均增加,VVI组,从34±7增至42±7 mm(P<0.01),AAI组,从34±8增至37±6 mm(P<0.05),但VVI组较AAI组增加更明显(P<0.01)。结论 长期VVI起搏可导致心衰加重。
Abstract:
AIM In patients with sick sinus syndrome, choice of pacing mode has been implicated in the development of congestive heart failure. METHODS One hundred sixty-five patients with sick sinus syndrome and intact atrioventricular conduction were implanted either single-chamber atrial pacing(AAI,n=72) or single-chamber ventricular pacing(VVI,n=93). Clinical assessment included heart function, medication, and echocardiography before pacemaker implantation, after 3 months, and subsequently once every year.RESULTS At long-term follow-up 5~8 years ( 5.5±2.1 years), heart function increse in NYHA(New York Heart Association) class was observed in 35 of 93 patients(38%) in the VVI group versus 8 of 72(11%) in the AAI group (P<0.01). Increase in dose of diuretic was significantly higher in VVI group than in the AAI group (24±38 versus 8±41 mg/d furosemide,P<0.01). The left ventricular ejection fraction decerased significantly in the VVI group (from 0.42±0.12 to 0.34±0.08,P<0.01) but not in the AAI group (from 0.40±0.13 to 0.38±0.09P>0.01). The left atrial diameter increased significantly in both treatment groups (VVI group: from 34±7 to 42±7 mm,P<0,01; AAI group:from 34±8 to 37±6 mm,P<0.01), but the increase was significantly higher in the VVI group than in the AAI group (P<0,01).CONCLUSION Long-term ventricular pacing is associated with a higher incidence of congestive heart failure and consumption of diuretics than atrial pacing.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2001-08-28.
更新日期/Last Update: 2002-11-01