双腔起搏器单左室起搏通过频率适应性房室延迟实现心脏再同步治疗

Three chamber pacemaker realize cardiac resynchronization therapy (CRT) by biventricular pacing . The definite effectiveness of CRT has been demonstrated in patients with chronic congestive heart failure (CHF), however, approximately 30% of patients with CHF do not respond to CRT. This phenomenon may be explained by the recurrence of atrio-ventricular and intraventricular dyssynchronization which caused by the fixed and shorten atrio-ventricular delay (AVD) and right ventricular pacing are inconsistent with physiological pacing. In previous study, we realized CRT by ventricular sense response pacing and rate adaptive atrio-ventricular delay with left ventricular pacing alone, respectively. Our results showed that restore the physiological conduct and activation sequence of right atrio - ventricle and right ventricle, and pacing left ventricle simultaneously are more physiological than traditional CRT, there is no need of interval optimization which is time-consuming , moreover, battery life can be extended due to not necessary to pacing right ventricle and the average annual cost of CRT can be decreased .This study aim at realizing CRT using dual-chamber pacemaker which tracing physiological PR interval of right atrio -ventricle by rate adaptive atrio-ventricular delay, and investigate whether realize CRT using dual-chamber pacemaker with rate adaptive atrio-ventricular delay can be substitute or superior to three chamber pacemaker which used extensively .

三腔起搏器通过双心室起搏实现心脏再同步治疗(CRT)慢性充血性心力衰竭(CHF),取得了确切疗效,但仍有约30%的患者经CRT治疗,效果不满意,这与为保证双室起搏设置短而固定的房室延迟及右室起搏有悖于生理性起搏,又造成新的房室及室内不同步有关。我们前期的研究分别通过右室感知触发左室起搏及频率适应性房室延迟单左室起搏实现CRT,结果表明:恢复右侧房室及右室的生理性激动顺序同时起搏左室的CRT模式更符合生理性,不仅无须繁琐的室间间期优化,而且因右室电极不需耗电起搏可延长电池寿命,间接降低CHF治疗费用。本研究拟应用双腔起搏器单左室起搏,通过频率适应性房室延迟跟踪右侧生理性PR间期实现CRT,以明确带频率适应性房室延迟功能的双腔起搏器治疗CHF的疗效是否优于或可替代目前广泛应用的三腔起搏器。

三腔起搏器通过双心室起搏实现心脏再同步治疗(CRT)慢性充血性心力衰竭(CHF),取得了确切疗效,但仍有约30%的患者经CRT治疗,效果不满意,这与为保证双室起搏设置短而固定的房室延迟及右室起搏有悖于生理性起搏,又造成新的房室及室内不同步有关。我们提出应用双腔起搏器单左室起搏,通过频率适应性房室延迟跟踪右侧生理性PR间期可实现CRT,以明确带频率适应性房室延迟功能的双腔起搏器治疗CHF的疗效是否优于或可替代目前广泛应用的三腔起搏器。本研究选取收住昆明医科大学第一附属医院，符合2013年ACC/AHA指南CRTⅠ类适应证的慢性充血性心衰患者64例。符合入选标准者进入研究，给予最佳药物治疗并植入起搏器，入选频率适应性房室延迟单左室起搏实现心脏再同步化组32例为研究组。研究组患者术后在心脏彩超指标及心电图QRS波时限监测下，兼顾房室结的前提下，设定优化的AVD，依据术前行动态心电图所采集的患者心率变化与PR间期变化关系的回归方程，设置最佳的个体化的房室间期（AVD），并将个体化的房室间期（AVD）程控入起搏器并打开频率适应性房室延迟功能，使频率适应性房室延迟单左室起搏组左侧AVD始终跟踪右侧房室的生理性PR间期。标准双室起搏组植入三腔起搏器患者在心脏彩超指标及QRS波时限监测下按常规优化方式进行AV、VV间期的优化。两个组分别予术后1、3、6个月，1年动态临床随访，比较心电图，心脏心超指标，临床指标等，研究结果：1.频率适应性房室延迟单左室起搏实现心脏再同步化治疗更符合生理性，安全,可行。2.频率适应性房室延迟单左室起搏实现心脏再同步化治疗可改善患者的临床心衰症状，心脏彩超急性血流动力学指标等，效果不劣于标准双心室起搏。3.频率适应性房室延迟单左室起搏实现心脏再同步化治疗可延长电池使用寿命，降低治疗费用，简化起搏器优化程序，具有推广应用前景。