CAJ | 학술논문

目的评估心力衰竭伴永久性心房颤动心脏再同步治疗(CRT)的长期疗效,分析影响疗效的相关因素.方法 33例心力衰竭伴永久性心房颤动接受CRT治疗的患者,其中单纯双心室起搏26例,双心室起搏+房室结消融7例,随访6～48个月,观察CRT术前及术后各时间点的心功能指标.结果按术后6个月左心室射血分数(LVEF)是否增加15％分为CRT应答组和无应答组,应答组24例,无应答组9例.在4年的随访中,死亡6例,两组各3例.术前基础状况比较,CRT无应答组LVEF高于CRT应答组(37％比32％,P＜0.01).经多因素logistic回归分析提示,心力衰竭病程、肺动脉压及48个月双心室起搏比例均是永久性心房颤动伴心力衰竭患者CRT无应答的独立危险因素,无应答组心力衰竭的病史更长(6年比4年,P＜0.05)、肺动脉压力明显增高[53比32mm Hg(1 mm Hg=0.133 kPa),P＜0.05],双心室起搏比率少(76％比92％,P＜0.01).结论心力衰竭伴永久性心房颤动接受CRT治疗长期观察亦有较好的疗效,无应答比例与窦律相当.影响CRT疗效的因素主要有心力衰竭的病程、肺动脉压力增高及双心室起搏比例,房室结消融是增加双心室起搏比率的有效方法,但大部分患者用β受体阻滞剂能达到满意的双心室起搏比率,若药物不能控制心率或不能耐受者,建议行房室结消融术.
목적 평고심력쇠갈반영구성심방전동심장재동보치료(CRT)적장기료효,분석영향료효적상관인소.방법 33례심력쇠갈반영구성심방전동접수CRT치료적환자,기중단순쌍심실기박26례,쌍심실기박+방실결소융7례,수방6～48개월,관찰CRT술전급술후각시간점적심공능지표.결과 안술후6개월좌심실사혈분수(LVEF)시부증가15％분위CRT응답조화무응답조,응답조24례,무응답조9례.재4년적수방중,사망6례,량조각3례.술전기출상황비교,CRT무응답조LVEF고우CRT응답조(37％비32％,P＜0.01).경다인소logistic회귀분석제시,심력쇠갈병정、폐동맥압급48개월쌍심실기박비례균시영구성심방전동반심력쇠갈환자CRT무응답적독립위험인소,무응답조심력쇠갈적병사경장(6년비4년,P＜0.05)、폐동맥압력명현증고[53비32mm Hg(1 mm Hg=0.133 kPa),P＜0.05],쌍심실기박비솔소(76％비92％,P＜0.01).결론 심력쇠갈반영구성심방전동접수CRT치료장기관찰역유교호적료효,무응답비례여두률상당.영향CRT료효적인소주요유심력쇠갈적병정、폐동맥압력증고급쌍심실기박비례,방실결소융시증가쌍심실기박비솔적유효방법,단대부분환자용β수체조체제능체도만의적쌍심실기박비솔,약약물불능공제심솔혹불능내수자,건의행방실결소융술.
Objective To evaluate the long-term effects and analyze causes of non-response to cardiac resynchronization therapy (CRT) in heart failure (HF) patients with permanent atrial fibrillation (AF).Methods Thirty-three patients with HF and AF [29 men,mean age (61 ± 10) years,NYHA class Ⅲ or IV,left ventricular ejection fraction(LVEF) ≤35％,QRS ≥ 120 ms in 31 cases] underwent biventricular pacing ( n =26 ) or bi-ventricular pacing and atrioventricular node ablation ( AVN-ablation,n =7 ) were included in this study.Non-response was defined:the increase of left ventricular ejection fraction (LVEF) was less than 15％.Patients were followed-up for 4 years.Results Six patients died during follow up.Non-responder to CRT was observed in 6 out of 27 survived patients (22.22％).Six out of 7 patients underwent AVN-ablation were in responder group and 1 in non-responder group.Comparing with responder group,the baseline LVEF was significantly higher (37％ vs.32％,P =0.003),and the history of HF was significantly longer ( 6.3 years vs.4.1 years,P =0.039 ),pulmonary artery pressure was significantly higher (53 vs.32 mm Hg,P =0.027),bi-ventricular pacing percentage ( BIVP％ ) was significantly lower (75.86％ vs.91.73％,P =0.007) in non-responder group.Conclusions Higher LVEF,longer HF history,higher pulmonary artery pressure and lower BIVP％ are factors linked with non-responses to CRT in this patient cohort.CRT plus AVN-ablation is associated with high response rate to CRT in this patient cohort.