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目的评估心脏再同步化治疗(CRT)对心力衰竭(简称心衰)合并持续性心房颤动(简称房颤)患者的疗效。方法 12例慢性心衰的持续性房颤患者,心室率本身是慢的或经过药物治疗严格控制心室率,成功植入CRTD并打开心室感知反应及房颤传导反应功能。比较CRT-D植入术前和植入术后1年患者的总体幸福感量表(GWB)及心脏病症状评分(CSS),6 min步行试验,心功能分级以及超声心动图指标:左房内径(LAD)、左室舒张末期内径(LVDD),左室射血分数(LVEF),二尖瓣返流面积(MRA),心室间机械运动延迟(IVMD),左室12节段达峰时间标准差(12-Ts-SD)和左室12节段达峰时间最大差值(12-TP-MAX-D)。结果①12例随访1年内均无因心功能恶化再次入院,无死亡。②双室有效起搏比率达到93%±5%。③有3例在CRT-D植入后自行转复为窦性心律。④CRT-D植入后1年GWB、CSS,6 min步行试验,心功能分级较植入前均有明显改善[(70.25±16.61)vs(54.62±15.27),(16.67±5.23)vs(9.28±4.52),(320±65.24)m vs(214±43.74)m,2.43 vs 3.30,P均<0.05];CRT-D植入后1年,LAD缩小,LVEF升高,MRA减少[(40.2±10.6)mm vs(47.5±12.3)mm,(0.40±0.07)vs(0.28±0.05),(3.8±1.6)cm2vs(5.6±2.3)cm2,P均<0.05];IVMD、12-Ts-SD和12-TP-MAX-D得到改善[(35.4±17.8)ms vs(48.1±12.3)ms,(31.5±10.7)ms vs(44.5±15.2)ms,(100.6±22.9)ms vs(127.5±42.7)ms,P均<0.05]。结论慢心室率或经过药物治疗严格控制心室率的持续性房颤合并心衰患者能从CRT-D治疗中获益。
Objective To evaluate the effect of cardiac resynchronization therapy (CRT) on patients with congestive heart failure (HF) and persistent atrial fibrillation (AF). Methods Twelve patients with chronic atrial fibrillation who had chronic heart failure were treated with slow ventricular rate or ventricular rate after drug treatment. CRTD was successfully implanted and the ventricular response and atrial fibrillation conduction response were switched on. The overall well-being scale (GWB) and cardiac symptom score (CSS), 6-min walking test, cardiac function classification and echocardiography before CRT-D implantation and one year after CRT implantation were compared. Left atrium LAD, LVDD, LVEF, MRA, IVMD, standard deviation of peak time of 12 segments of left ventricle (12-Ts-SD) and the maximum difference of 12-TP peak time (12-TP-MAX-D). Results ① All the 12 patients were admitted to the hospital again without any deterioration of cardiac function within one year of follow-up, and no death was found. ② double-chamber effective pacing rate of 93% ± 5%. ③ In 3 cases, CRT-D implanted itself converted to sinus rhythm. ④ After 1-year GWB, CSS and 6-min walking test, the grading of cardiac function in CRT-D group was significantly improved compared with that before implantation [(70.25 ± 16.61) vs (54.62 ± 15.27) vs (16.67 ± 5.23) vs 4.52), (320 ± 65.24) m vs (214 ± 43.74) m, 2.43 vs 3.30 respectively, P <0.05]. One year after CRT-D implantation, LAD decreased, LVEF increased and MRA decreased [(40.2 ± 10.6 ) were significantly higher in IVMD, 12-Ts-SD and 12 (12.4 ± 12.3) mm vs (0.40 ± 0.07) vs (0.28 ± 0.05) and (35.4 ± 17.8) ms vs (48.1 ± 12.3) ms vs (31.5 ± 10.7) ms vs. (44.5 ± 15.2) ms vs (100.6 ± 22.9) ms vs (127.5 ± 42.7) ms , P <0.05]. CONCLUSIONS: Patients with sustained atrial fibrillation and heart failure who have a slow ventricular rate or who have been medically treated to strictly control ventricular rate can benefit from CRT-D therapy.