观察慢性心衰患者心脏再同步化治疗术后病情转归并分析.DOC

观察慢性心衰患者心脏再同步化治疗术后病情转归并分析 胡春芳1 张志远2 邱春光3 卢文杰3 韩战营3 陈晓杰3 （郑州大学第一附属医院 心内科 河南 郑州 450052） [摘要] 目的：观察慢性心衰患者心脏再同步化治疗（CRT）术后病情转归，对相关因素进行回顾性分析，以确定治疗对慢性心衰患者预后的意义。方法：对入选患者56例行CRT/CRT-D治疗。于起搏器置入前，置入后1，3，6，12，18，24个月进行定期随访评估，突发事件时及时行非预期随访。每次随访采集相关临床资料，程控并优化起搏治疗，根据心功能调整心衰治疗药物。结果：56例患者中，术后2例心源性猝死，2例心功能恶化，余52例心功能明显改善（LVEF:30.40±4.03 vs 36.40±4.72），总有效率达92.9%。16例有房扑/房颤记录，9例发展为持续性房颤，6例累计发生8次室性心律失常。多因素logistic回归分析提示完全性右束支传导阻滞，术中左室电极置入位置，术后心衰药物的调整，起搏参数的优化均是影响CRT术后病情转归的独立危险因素。结论：CRT是治疗慢性心力衰竭的有效方法。术前严格筛选适应证，术中选择最佳心室电极置入位置，术后加强起搏器的程控与随访，对各种心律失常及时正确的处理，有利于提高CRT的有效率，改善患者预后。 [关键词] 慢性心力衰竭 心脏再同步化治疗 房颤 室性心律失常 [中图分类号］R542.2 [文献识别码］A Outcome of cardiac resynchronization therapy in patients with chronic heart failure Hu Chunfang1，Zhang Zhiyuan2，Qiu Chunguang3，Lu Wenjie3,Han Zhanying3，Chen Xiaojie3 (Department of cardiology，The First Affiliated Hospital of Zhengzhou Medical University，Zhengzhou 450052，China) Corresponding author: Qiu Chunguang, Email：qcg123@163.com [Abstract] Objective To observe the outcome of cardiac resynchronization therapy (CRT) in patients with chronic heart failure(CHF) and explore the potential factors to improve it. Methods Fifty-six patients with class I indications for CRT received CRT or CRT-D. Clinical and echocardiographic date were regularly collected at baseline and at 1,3,6,12,18,and 24 months post resynchronization therapy and also emergency follow-up was conducted when unexpected events were encountered. Programmed proper rate and timing of the pacing interval and drugs were adjusted according to cardiac function at each visit. Results Two cases suffered sudden cardiac death,2 cases showed deterioration of cardiac function and the remaining 52 cases showed significant improvement in cardiac function compared to baseline(LVEF:30.40?.03 vs 36.40?.72), ngwith a total effective rate of 92.9%. Atrial flutter / atrial fibrillation were recorded in 16 cases, 9 patients developed persistent atrial fibrillation. Ventricular arrhythmias occurred in 6 patient