合適的左心室節律器可能優於雙心室節律器


  May 10, 2005 (紐奧良) -左心室(LV)-已成功超越雙室節律器,且副作用小於一半以上,德國研究人員在第26屆心臟節律協會科學年會做出上述發表。
  
  有9%的左心室節律器病患有心臟病死亡、心臟移植,或需要左心室輔助設備,使用雙室節律器比例為19%。
  
  HRS的計畫主席Dwight Reynolds醫師對此研究發表指出,本研究提升是否雙室節律器在重要參數,如必死性、心臟移植,及左心室輔助設備有益的可能性,大部份的人們不會冒然使用左心室節律器,因為資料必須經由較大的試驗證實。
  
  Reynolds博士指出,大量被植入的心臟裝置為雙室節律器,左心室節律器使用不多。
  
  本研究由在德國Bad Oeynhausen地區的North Rhine-Westphalia心臟中心的心臟病學家Jurgen Vogt及其同事,針對378位在1999至2004年間植入心臟再同步化裝置的病患,其中包括91位植入左心室節律器病患進行分析;Voyt指出,在病患的基礎線特性,如性別、冠狀動脈疾病、心搏出率沒有顯著的差異。
  
  Vogt博士表示,在9個月的追蹤期間, VO2峰值、左心室末端的心臟舒張直徑,及生活品質在左心室節律器組及雙室節律器組均獲得改善;他指出,就兩組的這些參數而言,在統計上並沒有顯著的差異。
  
  但兩年後,副作用在兩組間有巨大的差異,相較於左心室節律器組,植入雙室節律器組在心臟病死亡、心臟移植及需要LV輔助裝置,有較高的影響。
  
  Vogt表示,雙室節律器組有較高的副作用,因為節律器在右心室;相較於左心室,右心室通常沒有類似時間傳導的問題,因此並不需要在每一個病例都調節右心室,那對部分病患而言是種傷害;他強調,植入雙極誘導和精心程式化的最佳化心臟節律模組,是改善植入心臟再同步化裝置成功率的解決方案。
  
  Vogt博士指出,雖然研究發現有其另人滿意的顯著性,但在實務上有任何改變前,進一步加入控制組對照研究是必須的。
  
  Vogt博士是Guidant公司的顧問,本研究的其他研究者表示沒有利益上的衝突。
  
  HRS第26屆科學會議,海報109,2005-5-6 發表。

Tailored LV-Only Pacing May Be

By
Medscape Medical News

Linda Little

May 10, 2005 (New Orleans) — Left ventricular (LV)–only pacing has marked success over biventricular pacing, with less than half the number of adverse events, German researchers reported here at the Heart Rhythm Society 26th annual scientific sessions.

Nine percent of patients with LV pacing had cardiac death, heart transplant, or required an LV assist device compared with 19% of patients treated with biventricular pacing.

“The study raises the possibility of whether biventricular pacing is advantageous on the important parameters such as mortality, heart transplant, and [LV] assist device,” Dwight Reynolds, MD, program chairman of the HRS, said, commenting on the study. “A lot of people won’t jump on this and start doing [LV] pacing because the data needs to be verified by a larger trial.”

Dr. Reynolds said that the vast majority of implantable cardiac devices are biventricular pacing devices, and he noted that "there is not a lot of [LV] pacing."

The study, conducted by Jurgen Vogt, MD, a cardiologist with Heart Center North Rhine-Westphalia in Bad Oeynhausen, Germany, and colleagues, included 378 patients who had a cardiac resynchronization device implanted between 1999 and 2004, which included 91 patients treated with LV-only pacing. Dr. Voyt reported that there was no significant difference in the baseline characteristics of the patients with respect to sex, coronary artery disease, or ejection fraction (mean, 24%).

During nine-month follow-up, peak VO2, LV end diastolic diameter, and quality of life improved in both the LV-pacing cohort and in the biventricular-pacing cohort, Dr. Vogt said. “There was no statistically significant difference between the groups” in these parameters, he said.

But at two years, adverse outcomes were dramatically different between the two groups. Those treated with biventricular pacing had a higher incidence of cardiac death, heart transplants, and the need for LV assist devices than the LV-only pacing group.

Adverse events may be higher in the biventricular-pacing group because of the pacing in the right ventricle, said Dr. Vogt. “The right ventricle usually doesn’t have the same conduction time problems as the left ventricle. It’s not necessary in every case to pace the right ventricle. It might be harmful in some patients.” He noted that “implantation of bipolar leads and careful programming of the optimal chronic pacing mode is the clue to improved success in [cardiac resynchronization therapy].”

Although the study findings were statistically significant, further study with a control group is needed before any change in practice is made, Dr. Vogt said.

Dr. Vogt is a consultant/advisor with Guidant Corp. Other researchers in the study had no financial conflicts of interest to report.

HRS 26th Annual Scientific Sessions: Poster 109. Presented May 6, 2005.

Reviewed by Gary D. Vogin, MD

Linda Little is a freelance writer for Medscape.

    
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