拡張性心筋病と心室伝導遅延の患者の急性VDDペースから左心室のメカニズムが改善されました
1Division of Cardiology, Department of Medicine, the Johns Hopkins Medical Institutions, Baltimore, MD, USA. dkass@eureka.wbme.jhu.edu
Circulation
|March 30, 1999
まとめ
導電遅延の心不全患者における単一部位心室ペースは,双心室ペースと同じくらい効果的に左心室機能を改善することができます. 最大の遅延の場所でのペースは,重要な血液動力学的利点を提供します.
科学分野:
- 心臓病学 心臓病学
- 電気生理学 電気生理学
- 心不全管理について
背景:
- 静脈ペースは心不全で使用されますが,左静脈 (LV) 機能に対するその影響は,静脈ペースの場所と心房静脈 (AV) 遅延に依存します.
- 静脈内伝導の遅延がペース反応に及ぼす影響は完全に理解されていません.
研究 の 目的:
- 心不全患者におけるLV機能に対する異なるペースサイトとAV遅延の直接的な影響を調査する.
- 導電遅延が最も大きい場所での単一サイトペースは,二心房ペースと同じくらい効果的であるという仮説を検証する.
主な方法:
- 18人の心不全患者で,LVエジェクション分数が減少した患者は,様々な部位で心室ペース (VDD) とAV遅延を受けた.
- 測定対象は,大動脈と動脈圧,dP/dtmax,脈圧,圧力-体積ループなどでした.
- データは,正常な副鼻腔リズムと二心房ペースと比較した.
主要な成果:
- 左心室 (LV) のフリーウォールペースは,右心室 (RV) のペースと比較して,dP/dtmaxと脈圧を著しく増加させた.
- ビビントリキュラーペースは,LVペースよりもdP/dtmaxの改善が少ないことを示した.
- 最適なAV間隔は平均125msで,ペースサイトはAV遅延よりも大きな影響を及ぼしました.
- 導導遅延パターンは,効果的なペースサイトを予測しました.
結論:
- 静脈ペースは,静脈内伝導が遅れている心不全患者の静脈内収縮機能を急激に強化します.
- 最大の遅延部位における単一部位ペースアップは,二心房ペースアップに匹敵する,または優れている利点を提供します.
- これらの発見は,ペースメカニズムを明確にし,将来の研究のために患者を選択するのに役立ちます.
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