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|本期目录/Table of Contents|

起搏依赖患者长期右心室尖起搏致起搏诱导性心肌病临床分析

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2013年第2期
页码:
200-203
栏目:
临床研究
出版日期:
2013-04-25

文章信息/Info

Title:
Clinical study on pacing-induced cardiomyopathy resulting from long-time right ventricular apical pacing in pacemaker-dependent patients
作者:
王秋林; 周 鹏; 蔡国才; 蒋利成; 李文章; 蒲 静; 梁登攀
(成都医学院第一附属医院心内科，四川 成都 610500)
Author(s):
WANG Qiu-lin;  ZHOU Peng;  CAI Guo-cai;  JIANG Li-cheng;  LI Wen-zhang;  PU Jing;  LIANG Deng-pan
(Department of Cardiology, First Affiliated Hospital, Chengdu Medical College, Chengdu 610500, Sichuan, China)
关键词:
起搏器; 起搏器依赖; 右室心尖部起搏; 起搏诱导性心肌病; 左室射血分数; 左室舒张末期内径
Keywords:
pacemaker-dependent;  right ventricular apical pacing;  pacing-induced cardiomyopathy;  left ventricular ejection fraction;  left ventricular end-diastolic diameter
分类号:
R542.2
DOI:
-
文献标识码:
A
摘要:
目的:评估长期右室心尖部起搏致起搏依赖患者起搏诱导性心肌病（PiCMP）的临床情况。方法： 回顾性分析近10年来本院右室心尖部起搏患者的临床资料，纳入标准为持续2年以上右室心尖部起搏依赖的患者，起搏器植入时无结构性心脏病。起搏诱导性心肌病定义为：左室射血分数（LVEF）≤45%，右室起搏时心脏运动障碍，不伴其他已知原因的心肌病。所有患者均行心脏超声检查，完成6分钟步行试验、测量血浆脑钠尿肽（BNP）水平，并让患者填写明尼苏达心功能不全生存质量调查表对患者生活质量进行评分。结果： 门诊患者中有55例符合纳入标准，诊断为PiCMP 8例。超声心动图显示与正常心功能患者相比，PiCMP患者存在明显的左室重构［LVEF：(41±4)% vs.(62±6)%,P<0.05； 左室舒张末期内径（LVEDD）：(55±3) mm vs.(45±4) mm，P<0.05］,两组患者年龄、性别、右室起搏时间、左右心室间传导延迟、QRS时限以及动脉血压均无显著差异。PiCMP患者运动能力、生活质量评分以及血浆BNP水平明显差于非PiCMP患者。结论： 长期右心室尖起搏致PiCMP的发病率不高，但会严重影响患者生活质量，其形成与长期右心室尖起搏引起左室重构有密切。
Abstract:
AIM:To evaluate the prevalence of pacing-induced cardiomyopathy (PiCMP) resulting from long-time right ventricular apical pacing (RVAP) in pacemaker-dependent patients. METHODS: Clinical data of patients with prolonged pacing from the apex of the right ventricle were analyzed retrospectively. Inclusion criteria were right ventricular apex stimulation for at least 2 years, pacemaker dependency and absence of structural heart disease at the time of initial implantation. PiCMP was pre-defined as left ventricular ejection fraction (LVEF)≤45%, dyskinesia during RV pacing and absence of other known causes of cardiomyopathy. All patients were examined by echocardiography and their plasma brain natriuretic peptide (BNP) levels were detected. All patients underwent 6-min walking test (6MWT) to assess the exercise capacity and quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). RESULTS: Fifty-five patients from our Outpatient Department met the inclusion criteria. PiCMP was diagnosed in eight patients (14.5%). Echocardiography showed significant LV remodeling in PiCMP patients ［LVEF (41.2±4.4)%, LV end-diastolic diameter (LVEDD) (55.3±3.2) mm］ compared with that in patients with preserved LVEF ［LVEF (62.3±6.5)%, P<0.05, LVEDD (45.2±4.1) mm, P<0.05］. No significant differences were found in age, gender, duration of RV pacing, heart rate, interventricular mechanical delay, QRS duration and arterial hypertension between groups. Exercise capacity, quality of life and plasma BNP level of PiCMP patients were lower than those of patients with preserved LVEF. CONCLUSION: The prevalence of PiCMP is remarkably low, but PiCMP could severely affect the quality of life. PiCMP is associated with pronounced LV remodeling resulting from RVAP.

参考文献/References

[1]Yu CM,Chan JY,Zhang Q,et al.Biventricular pacing in patients with bradycardia and normal ejection fraction[J].N Engl J Med,2009,361(22):2123-2134.
[2]Thambo JB,Bordachar P,Garrigue S,et al.Detrimental ventricular remodeling in patients with congenital complete heart block and chronic right ventricular apical pacing[J].Circulation,2004,110(25):3766-3772.
[3]Nazeri A,Massumi A,Rasekh A,et al.Cardiac resynchronization therapy in patients with right ventricular pacing-induced cardiomyopathy[J].Pacing Clin Electrophysiol,2010,33(1):37-40.
[4]Nagatomo T,Abe H,Kikuchi K, et al. New onset of pacemaker dependency after permanent pacemaker implantation［J］. Pacing Clin Electrophysiol,2004,27(4):475-479.
[5]Sweeney MO,Hellkamp AS.Heart failure during cardiac pacing[J].Circulation,2006,113(17):2082-2088.
[6]O Keefe JH Jr,Abuissa H,Jones PG,et al.Effect of chronic right ventricular apical pacing on left ventricular function[J].Am J Cardiol,2005,95(6):771-773.
[7]Spragg D,Leclercq C,Loghmani M,et al.Regional alterations in protein expression in the dyssynchronous failing heart[J].Circulation,2003,108(8):929-932.
[8]Dreger H,Maethner K,Bondke H,et al.Pacing-induced cardiomyopathy in patients with right ventricular stimulation for >15 years[J].Europace,2012,14(2):238-242.
[9]Tse HF,Wong KK,Siu CW,et al.Upgrading pacemaker patients with right ventricular apical pacing to right ventricular septal pacing improves left ventricular performance and functional capacity[J].J Cardiovasc Electrophysiol,2009,20(8):901-05.
[10]Boriani G,Biffi M,Martignani C,et al.Is cardiac resynchronization therapy cost-effective?[J].Europace,2009,11(Suppl 5):v93-v97.

备注/Memo

备注/Memo:
收稿日期：2012-09-05.基金项目：四川省卫生厅基金项目资助(100102) 作者简介：王秋林，副教授，博士 Email:wangredox@163.com
更新日期/Last Update: 2013-04-28