儿童左室高位侧后壁心外膜起搏对心功能的远期影响
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摘要
目的观察和分析接受长期左室高位侧后壁心外膜起搏治疗后患儿左心室功能改变情况,探讨最佳的心外膜电极植入位置。方法回顾2008年11月至2016年8月收治的56例植入左室心外膜起博电极患儿术前及末次随访的临床情况及超声检查结果,并对患儿两次超声结果进行统计分析。结果 56例患儿中包括先天性心脏病术后31例、先天性及心肌炎后缓慢性心律失常25例。首次起搏器治疗中位年龄3.25岁,随访中位时间1.63年。超声检查显示术前左心室射血分数(LVEF)、左心房内径(LA)分别为(66.39±9.96)%和(25.48±7.22)mm,末次随访为(69.32±7.13)%和(23.44±6.29)mm,差异均有统计学意义(P<0.05);末次随访左心室舒张末期内径(LVDd)和左心室收缩末期内径(LVDs)Z评分为-1.42(-4.67～0.89)和0.06(-2.39～2.72),相比术前的0.16(-1.31～2.83)和-1.88(-4.48～0.10)均显著缩小,差异有统计学意义(P<0.05)。结论左室高位侧后壁起搏能够有效保护和改善左室功能,是儿科治疗缓慢性心律失常起搏电极理想的心外膜植入位置。
Objective To observe and analyze the changes of left ventricular function after long-term left ventricular high lateral posterior wall epicardial pacing, and to explore the optimal location of epicardial electrode implantation. Methods Clinical and echocardiography data before operation and at last follow-up in 56 children implanted left ventricular high lateral wall epicardial pacing electrode from November 2008 to August 2016 were retrospectively analyzed. The results of two ultrasound examinations were analyzed. Results Among the 56 cases, 31 had postoperative bradyarrhymia, and 25 had congenital or myocarditis bradyarrhymia. The median age at the implantation was 3. 25 years, and the median follow-up period was 1. 63 years. Ultrasound examination showed that preoperative left ventricular ejection fraction(LVEF) and left atrial(LA) diameter were(66.39±9.96) % and(25.48±7.22) mm respectively, and LVEF and LA diameter at the last follow-up were(69.32±7.13) %and(23.44±6.29) mm respectively, and the differences were statistically significant(P<0.05). The left ventricular end diastolic diameter(LVDd) and left ventricular end systolic diameter(LVDs) Z scores were-1.42(-4.67～0.89) and 0.06(-2.39～2.72) at last follow-up, which were significantly reduced compared with 0.16(-1.31～2.83) and-1.88(-4.48～0.10) at preoperation, and differences were statistically significant(P<0.05). Conclusion High lateral posterior wall pacing of left ventricle can effectively protect and improve left ventricular function. It is an ideal location for epicardial implantation of pacing electrode in pediatric treatment of bradyarrhythmia.
Objective To observe and analyze the changes of left ventricular function after long-term left ventricular high lateral posterior wall epicardial pacing, and to explore the optimal location of epicardial electrode implantation. Methods Clinical and echocardiography data before operation and at last follow-up in 56 children implanted left ventricular high lateral wall epicardial pacing electrode from November 2008 to August 2016 were retrospectively analyzed. The results of two ultrasound examinations were analyzed. Results Among the 56 cases, 31 had postoperative bradyarrhymia, and 25 had congenital or myocarditis bradyarrhymia. The median age at the implantation was 3. 25 years, and the median follow-up period was 1. 63 years. Ultrasound examination showed that preoperative left ventricular ejection fraction(LVEF) and left atrial(LA) diameter were(66.39±9.96) % and(25.48±7.22) mm respectively, and LVEF and LA diameter at the last follow-up were(69.32±7.13) %and(23.44±6.29) mm respectively, and the differences were statistically significant(P<0.05). The left ventricular end diastolic diameter(LVDd) and left ventricular end systolic diameter(LVDs) Z scores were-1.42(-4.67～0.89) and 0.06(-2.39～2.72) at last follow-up, which were significantly reduced compared with 0.16(-1.31～2.83) and-1.88(-4.48～0.10) at preoperation, and differences were statistically significant(P<0.05). Conclusion High lateral posterior wall pacing of left ventricle can effectively protect and improve left ventricular function. It is an ideal location for epicardial implantation of pacing electrode in pediatric treatment of bradyarrhythmia.
引文
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[12]Upadhyay GA,Tung R.His bundle pacing for cardiac resynchronization[J].Card Electrophysiol Clin,2018,10(3):511-517.
[13]刘海菊,李小梅,崔建,等.经胸植入左心室心外膜永久起搏器治疗儿童完全性房室传导阻滞、完全性左束支传导阻滞的疗效及心脏同步性研究[J].中华实用儿科临床杂志,2016,31(23):1787-1791.
[14]曾少颖,石继军,杨平珍,等.左室同步化治疗儿童难治慢性心力衰竭[D].广州:第十七届全国小儿心血管疾病学术会议论文集.2012:169-170.
[15]汪菁峰,宿燕岗,柏瑾,等.左室起搏电极部位对心脏再同步化治疗疗效的影响[J].中国心脏起搏与心电生理杂志,2012,26(1):22-25.
[2]van Geldorp IE,Vanagt WY,Prinzen FW,et al.Chronic ventricular pacing in children:toward prevention of pacinginduced heart disease[J].Heart fail Rev,2011,16(3):305-314.
[3]Sluysmans T,Colan SD.Theoretical and empirical derivation of cardiovascular allometric relationships in children[J].JAppl Physiol(1985),2005,99(2):445-457.
[4]Wang SS,Hong WJ,Zhang YQ,et al.Regression equations for calculation of z scores for echocardiographic measurements of left heart structures in healthy Han Chinese children[J].J Clin Ultrasound,2018,46(5):328-333.
[5]Gebauer RA,Tomek V,Salameh A,et al.Predictors of left ventricular remodelling and failure in right ventricular pacing in the young[J].Eur Heart J,2009,30(9):1097-1104.
[6]Haycock GB,Schwartz GJ,Wisotsky DH.Geometric method for measuring body surface area:a height-weight formula validated in infants,children,and adults[J].J Pediatr,1978,93(1):62-66.
[7]Lau KC,William Gaynor J,Fuller SM,et al.Long-term atrial and ventricular epicardial pacemaker lead survival after cardiac operations in pediatric patients with congenital heart disease[J].Heart Rhythm,2015,12(3):566-573.
[8]Kim JJ,Friedman RA,Eidem BW,et al.Ventricular function and long-term pacing in children with congenital complete atrioventricular block[J].J Cardiovasc Electrophysiol,2007,18(4):373-377.
[9]Zhang ZM,Rautaharju PM,Soliman EZ,et al.Mortality risk associated with bundle branch blocks and related repolarization abnormalities(from the Women's Health Initiative[WHI])[J].Am J Cardiol,2012,110(10):1489-1495.
[10]Friehling M,Ludwig DR,Dunn M,et al.Deterioration of left ventricular ejection fraction and contraction synchrony during right ventricular pacing in patients with left bundle branch block[J].J Nucl Cardiol,2013,20(5):830-834.
[11]Janou?ek J,van Geldorp IE,Krupi?kováS,et al.Permanent cardiac pacing in children:choosing the optimal pacing site:a multicenter study[J].Circulation,2013,127(5):613-623.
[12]Upadhyay GA,Tung R.His bundle pacing for cardiac resynchronization[J].Card Electrophysiol Clin,2018,10(3):511-517.
[13]刘海菊,李小梅,崔建,等.经胸植入左心室心外膜永久起搏器治疗儿童完全性房室传导阻滞、完全性左束支传导阻滞的疗效及心脏同步性研究[J].中华实用儿科临床杂志,2016,31(23):1787-1791.
[14]曾少颖,石继军,杨平珍,等.左室同步化治疗儿童难治慢性心力衰竭[D].广州:第十七届全国小儿心血管疾病学术会议论文集.2012:169-170.
[15]汪菁峰,宿燕岗,柏瑾,等.左室起搏电极部位对心脏再同步化治疗疗效的影响[J].中国心脏起搏与心电生理杂志,2012,26(1):22-25.