The Clinical Study Of Treating Refractory Congestive Heart Failure By Right Atrial And Biventricular Pacing

Objective:To observe the clinical efficacy of treating chronic refractory congestive heart failure(CHF) by right atrial and biventricular pacing and discuss the underlying mechanism,To discuss the relation between position of left ventricular lead(LV lead) and the clinical efficacy. Method:Six patients with NYHA III~IV heart failure and complete left bundle block,left ventricle ejection fraction(LVEF) #0.35,and electrocardiographic QRS wave complex duration > 140ms were recruited.All patients received right atrial and biventricular pacing (Spatients were implanted with Medtronic Jnsync 8040 pacemakers and 2187 leads. 1 patient with Medtronic 7866 pacemaker and 2188 lead) . Application of coronary sinus (CS) mapping lead and CS angiograthy made it easier to implant LV lead.The LV lead final position:lateral in 2, the LV posterior vein of left ventricle in 2, the middle cardiac vein in 1 and the great cardiac vein in l.The effects of this therapy were assessed serially up to 3~20months after pacing by UCG,Holter,NYHA class and X-ray etc. Result: 6 patients were succeed in implanting LV lead.Compared with the corresponding values at baseline ,there was significant improvement of LVEF and 6 minute hall-walk distance, and decreasing in the diameter of atrial and ventricle after pacing for 3~20months.The reducing in mitral regurgitation,QRS duration and NYHA class were also observed. Conclusion:Biventricular pacing remarkably improves cardiac function in patients with CHF.Application of CS mapping lead and CS angiography may raise the successful rate of implanting LV lead.