在患有扩张性心肌病和心室导电延迟的患者中,从急性VDD节奏中改善左心室力学
1Division of Cardiology, Department of Medicine, the Johns Hopkins Medical Institutions, Baltimore, MD, USA. dkass@eureka.wbme.jhu.edu
Circulation
|March 30, 1999
概括
心力衰竭患者的单位心室节奏在导电延迟患者中可以改善左心室功能,与双心室节奏一样有效. 在延迟最大的地方节奏提供了显著的血液动力学益处.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 心脏衰竭管理的管理
背景情况:
- 心室节奏被用于心力衰竭,但它对左心室 (LV) 功能的影响取决于节奏部位和心房 (AV) 延迟.
- 内导电延迟对节拍反应的影响尚未完全理解.
研究的目的:
- 调查不同节奏点和AV延迟对心力衰竭患者的LV功能的直接影响.
- 为了测试这样的假设,即在传导延迟最大的地方进行单位节拍与双心室节拍一样有效.
主要方法:
- 18名心力衰竭患者减少了LV射出分数,在各个部位进行了心室节奏 (VDD) 和AV延迟.
- 测量包括大动脉和LV压力,dP/dtmax,脉冲压力和压力-体积循环.
- 数据与正常的鼻节律和双心脏节奏相比较.
主要成果:
- 与右心室 (RV) 节奏相比,左心室 (LV) 自由壁节奏显著增加dP/dtmax和脉冲压.
- 双动脉节拍显示dP/dtmax的改善不如LV节拍.
- 最佳的AV间隔平均为125毫秒,节奏部位的影响比AV延迟更大.
- 导电延迟模式预测了有效的节奏点位.
结论:
- 静脉节奏急剧增强心力衰竭患者内静脉导电延迟的LV收缩功能.
- 在最大延迟部位的单位节奏提供了与双心室节奏相比或优于双心室节奏的好处.
- 这些发现澄清了节奏机制,并有助于为未来的研究选择患者.
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