优化AV间期对伴有二尖瓣反流的双腔起搏器植入患者效应观察被引量：4

Efficacy of optimized atrioventricular delay in dual-chamber(DDD)pacemaker-patients with isolated mitral regurgitation

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摘要目的:因完全性房室传导阻滞植入双腔起搏器(DDD)患者日益增多,通过起搏器参数调整可改善心功能,提高生活质量。本研究分析伴有二尖瓣反流(MR)的DDD植入者,短期和长期在最佳房室间期(AVI)是否能改善MR、增加每搏输出量(SV)。方法:对2010~2013年的30例植入DDD伴MR的患者随机分为程控组(16例)和对照组(14例),起搏频率均为70次/min。术后2d程控组在心脏超声监测下程控起搏器,达到最佳AVI,即反流程度[反流容量(RV)、分数(RF)以及面积(RA)]减少和SV增加,并在术前、术后2d和3个月随访LVEF、BNP和NYHA分级等。结果:术后2d,在最佳AVI[(96±11)ms]内,程控组中MR程度减少和SV增加(P<0.01);程控组与对照组相比亦有同样变化(P<0.01)。术后3个月与术后2d相比程控组无进一步的MR减少和SV增加(P>0.05);而LVEF、BNP、NYHA分级、6min步行距离、再住院率和病死率差异亦无统计学意义。结论:缩短AVI可以减少MR程度并增加每分输出量,改善心功能,但最佳AVI个体差异大。本研究随访时间短,全起搏所带来的远期效应并不明确,需要长期随访及大量临床试验进一步研究。 Objective：Today,more patients were treated with dual-chamber（DDD）pacemaker for complete atrioventricular（AV）block,by which programmed adjustment of parameters can provide an optimal cardiac output to enhance the quality of life and prolong survival.In this study,we aimed to identify the＇ideal atrioventricular（AV）delay＇and to determine the effect of short and long term pacing with ideal AV delay on mitral regurgitation（MR）degree and cardiac stroke volume in DDD pacemaker-patients with isolated MR.Method：We conducted a study in 30 DDD pacemaker recipients from 2010 to 2013.The patients were randomly divided into programmed group（n=16）and control group（n=14）at a rate of 70pulses/minute.The ideal AV delay was selected using echocolor Doppler parameters after 2days in programmed group and was defined as that resulting in a lower degree of MR（evaluated by regurgitant volume（RV）and fraction（RF）and regurgitant jet area（RA））and in the highest cardiac output.Clinical evaluation,brain natriuetic peptide（BNP）levels,left ventricular ejection fraction（LVEF）and New York Heart Association（NYHA）functional class were analysed before and 2day,3mouth after the implantation.Result：The mean＇optimal＇AV delay was 96±11ms.After 2days of follow-up at short AV delay in the programmed group,we observed a significant reduction in MR severity（RV,RF,RA reduced by 29±3,18±4,6±2respectively with P〈0.01）together with an increase in stroke volume（20±4with P〈0.01）.The same change was also showed in the programmed group compared with control group（25±3,19±4,7±2,25±8,P〈0.01）.However,There were no further reduction in MR and increase in SV in the programmed group after 3months compared to the time point of 2days.Conclusion：In conclusion,a short AV delay may be used to improve cardiac output and reduce MR severity.Nevertheless,the optimal AVI is a highly individual characteristic of each patient.A large scale and long time study is necessary to evaluate the b