31例难治性慢性心力衰竭心脏再同步化治疗的疗效观察

目的 总结31例难治性慢性心力衰竭(心衰)患者接受心脏再同步化治疗(CRT)的疗效及临床经验.方法 31例难治性慢性心衰患者,通过药物治疗(28例)或结合床旁连续性肾脏替代治疗(3例)改善心功能后接受CRT治疗.左心室电极置入过程中采用了中空造影导管直接显影(11例)、带球囊的造影导管进行充气造影(20例)来显示冠状静脉窦及其分支.合并心房颤动患者(3例)仅置入左、右心室电极.伴有血液动力学障碍的室性心动过速/心室颤动患者(4例),置入双心室再同步自动复律除颤器(CRT-D).全部患者术前1周接受心电图、24 h动态心电图、超声心动图、临床心功能评价,并在术后6、12、18、24个月时随访上述检查.结果 31例患者均顺利完成起搏器置入术,1例置入CRT-D的患者术后3 d因出现多脏器功能衰竭死亡,1例置入CRT的患者在术后5个月时发生猝死,2例患者分别于3、6个月时失访;余27例患者随访结果显示,术后QRS平均时限较术前缩短,临床评价及超声测定的心功能情况明显改善,3例置入CRT-D的患者再发恶性室性心律失常时全部经电除颤成功转复为窦性心律.结论 CRT能改善难治性慢性心衰患者的心功能,提高患者的生活质量.CRT-D可以有效治疗恶性室性心律失常,预防猝死发生.

Efficacy of cardiac resynchronization therapy for patients with refractory congestive heart failure

Objective To observe the efficacy of cardiac resynchronization therapy for patients with refractory congestive heart failure. Methods Thirty-one patients with refractory congestive heart failure received cardiac resynchronization therapy. Before operation, all patients received standard drug therapy (28 cases) or integrated with CRRT (3 cases). Coronary sinus and its branches were shown by direct angiography with hollow angiographic catheter(11 cases)and by balloon angiographic catheter (20 cases). Left ventricle and right ventricle electrodes were implanted to 3 patients with atrial fibrillation, 4 patients with paroxysmal ventricular tachycardia or ventricular fibrillation received CRT-D implantation. electrocardiogram, 24 hours Holter, echocardiography and physical clinical examinations were made at baseline, 6, 12,18 and 24 months post resynchronization therapy. Results Pacemakers were successfully implanted in all 31 patients. One patient implanted with CRT-D died of multiple organ failure on third day after operation, 1 patient suffered sudden cardiac death 5 months after therapy and 2 patients were lost to fellow up 6 and 12 months after operation, respectively. Results from the remaining 27 patients showed that QRS duration was significantly decreased ( 153±8.4 at baseline vs. 132±9.8 at 24 months follow up) and cardiac function significantly improved (LVEF 0.29±0.10 at baseline vs. 0.41±0.11 at 24 months follow up, P<0.05 vs. baseline) during follow up compared to baseline. Malignant ventricular arrhythmia occurred in 3 patients with CRT-D and successfully terminated and converted to sinus rhythm. Conclusions Cardiac resynchronization therapy could improve cardiac function for patients with refractory congestive heart failure. CRT-D can effectively terminate the malignant ventricular arrhythmia.