Electrophysiological alterations after left ventricular assist device implantation in patients with end-stage dilated cardiomyopathy
-
摘要: 目的 探讨晚期扩张型心肌病患者行左心室辅助装置(left ventricular assist device，LVAD)植入术后心脏电生理的变化。方法 回顾性分析2018年5月—2023年3月于我院接受LVAD植入术的16例晚期扩张型心肌病患者的临床资料。比较术前、术后1 d以及术后1个月体表同步12导联心电图的变化。结果 LVAD植入术后1 d，肢体同步12导联心电图的QRS波群持续时间从(146.6±39.8) ms减少到(133.9±35.3) ms(P < 0.05)，绝对QT间期持续时间从(412.6±59.6) ms增加到(429.8±52.7) ms(P < 0.05)，心率校正QT间期(QTc)持续时间从(491.7±37.2) ms增加到(507.8±34.4) ms(P < 0.05)。LVAD植入术1个月以后，QT间期持续时间从(429.8±52.7) ms减少到(383.3±44.4) ms，QTc持续时间从(507.8±34.4) ms减少到(468.7±29.3) ms(均P < 0.05)。结论 LVAD植入后急性左心室卸负荷使QRS波持续时间减少，QTc间期持续时间增加。LVAD植入后延迟出现的QTc时间减少可能与心脏持续卸负荷期间的电生理逆向重构有关。Abstract: Objective To investigate the electrophysiological alterations after left ventricular assist device(LVAD) implantation for treating end-stage dilated cardiomyopathy.Methods The clinical data of 16 patients who received LVAD implantation due to end-stage dilated cardiomyopathy in our hospital from May 2018 to March 2023 were retrospectively analyzed. Electrocardiogram examinations were performed before, 1 day, and 1 month after LVAD implantation to monitor and evaluate changes in 12-lead electrocardiograms.Results The absolute QT duration[(412.6±59.6) ms vs(429.8±52.7) ms, P < 0.05], the heart rate-corrected QT interval(QTc) [(491.7±37.2) ms vs(507.8±34.4) ms, P < 0.05]were significantly increased at 1 day post LVAD implantation as compared to before LVAD implantation. However, the QRS duration[(146.6±39.8ms) vs(133.9±35.3) ms, P < 0.05]was significantly reduced than that before LVAD implantation. With sustained cardiac unloading via LVAD support, there was a marked decrease in the absolute QT duration[(412.6±59.6) ms vs(383.3±44.4) ms, P < 0.05]and QTc[(507.8±34.4) ms vs(468.7±29.3) ms, P < 0.05]after 1 month of LVAD implantation.Conclusion Electrocardiogram results show that LVAD could effectively reduce left ventricular load, decrease the QRS duration and increase the absolute QT and QTc duration. Delayed decreases in QTc after LVAD implantation may be related to the reversal of electrophysiologic remodeling during the continued unloading period of the heart.
-
-
表 1 LVAD植入前患者基本资料
Table 1. Baseline data of patients before LVAD implantation
患者编号 年龄/岁 性别 LVEF/% 心率/(次/min) RBBB LBBB LVEDd/mm sPAP/mmHg 1 40 男 29 60 - - 76 40 2 43 男 27 81 - + 68 26 3 39 男 18 80 - - 93 22 4 43 男 29 85 - - 91 50 5 58 男 21 97 - - 89 22 6 38 男 19 81 - - 76 23 7 61 男 25 80 - - 80 35 8 37 男 22 70 - - 77 46 9 52 女 18 94 - - 66 64 10 54 女 21 80 - - 86 59 11 49 男 25 109 - + 108 26 12 16 男 17 96 + - 65 53 13 67 女 35 111 - - 71 38 14 60 男 31 69 - - 68 23 15 14 男 19 126 - - 66 40 16 59 男 21 86 - - 83 47 1 mmHg=0.133 kPa。 
下载: 导出CSV
表 2 LVAD植入前与术后1 d心电图变化
Table 2. Changes in electrocardiogram indicators before and 1 day after LVAD implantation
ms, X±S 项目 术前(16例) 术后1 d(16例) 统计量 P值 心率/(次/min) 87.8±17.1 85.7±15.9 0.691 0.500 PR 178.4±55.2 160.1±33.8 1.364 0.173 QRS 146.6±39.8 133.9±35.3 2.356 0.018 QT 412.6±59.6 429.8±52.7 2.207 0.043 QTc 491.7±37.2 507.8±34.4 2.357 0.032
下载: 导出CSV
表 3 LVAD植入术后1 d与术后1个月心电图变化
Table 3. Changes in electrocardiogram indicators 1 day and 1 month after LVAD implantation
ms, X±S 项目 术后1 d(16例) 术后1个月(16例) 统计量 P值 心率/(次/min) 85.7±15.9 91.7±16.8 0.798 0.284 PR 160.1±33.8 175.1±25.5 1.442 0.170 QRS 133.9±35.3 130.3±33.2 0.425 0.776 QT 429.8±52.7 383.3±44.4 4.047 0.001 QTc 507.8±34.4 468.7±29.3 3.780 0.002
下载: 导出CSV
-
[1] 胡盛寿, 王增武. 《中国心血管健康与疾病报告2022》概述[J]. 中国心血管病研究, 2023, 21(7): 577-600.
[2] Schultheiss HP, Fairweather D, Caforio A, et al. Dilated cardiomyopathy[J]. Nat Rev Dis Primers, 2019, 5(1): 32. doi: 10.1038/s41572-019-0084-1
[3] Mages C, Gampp H, Syren P, et al. Electrical Ventricular Remodeling in Dilated Cardiomyopathy[J]. Cells, 2021, 10(10): 2767. doi: 10.3390/cells10102767
[4] Dandel M, Javier M, Javier Delmo EM, et al. Weaning from ventricular assist device support after recovery from left ventricular failure with or without secondary right ventricular failure[J]. Cardiovasc Diagn Ther, 2021, 11(1): 226-242. doi: 10.21037/cdt-20-288
[5] 郭继鸿, 王思让, 谭学瑞, 等. 心电图测量技术指南[J]. 实用心电学杂志, 2019, 28(2): 77-86.
[6] 刘鑫, 曲洪一, 王聪, 等. 第3代人工心脏泵研究进展及应用[J]. 中国生物医学工程学报, 2022, 41(3): 339-350.
[7] 施怡声, 朱振辉, 王浩, 等. 左心室辅助装置植入术围术期经食道超声心动图的应用研究[J]. 中国循环杂志, 2021, 36(6): 574-578.
[8] Sisti N, Santoro A, Carreras G, et al. Ablation therapy for ventricular arrhythmias in patients with LVAD: Multiple faces of an electrophysiological challenge[J]. J Arrhythm, 2021, 37(3): 535-543. doi: 10.1002/joa3.12542
[9] Guirguis B, Stout M, Elayi CS, et al. QRS Shortens after Left Ventricular Assist Device Implantation[J]. ASAIO J, 2019, 65(7): e66-e68. doi: 10.1097/MAT.0000000000000883
[10] Husti Z, Varró A, Baczkó I. Arrhythmogenic Remodeling in the Failing Heart[J]. Cells, 2021, 10(11): 3203. doi: 10.3390/cells10113203
[11] Kléber AG, Jin Q. Coupling between cardiac cells-An important determinant of electrical impulse propagation and arrhythmogenesis[J]. Biophys Rev(Melville), 2021, 2(3): 031301.
[12] Gopinathannair R, Cornwell WK, Dukes JW, et al. Device Therapy and Arrhythmia Management in Left Ventricular Assist Device Recipients: A Scientific Statement From the American Heart Association[J]. Circulation, 2019, 139(20): e967-e989.
[13] Kaki A, Subahi A, Shokr M, et al. Impella-Induced Incessant Ventricular Tachycardia[J]. Ochsner J, 2019, 19(3): 248-251. doi: 10.31486/toj.18.0018
[14] Mijailovich SM, Stojanovic B, Nedic D, et al. Nebulin and titin modulate cross-bridge cycling and length-dependent calcium sensitivity[J]. J Gen Physiol, 2019, 151(5): 680-704. doi: 10.1085/jgp.201812165
[15] Hamilton S, Terentyev D. Proarrhythmic Remodeling of Calcium Homeostasis in Cardiac Disease; Implications for Diabetes and Obesity[J]. Front Physiol, 2018, 9: 1517. doi: 10.3389/fphys.2018.01517
[16] 郭睿康, 池江洋, 严格, 等. 容积调控阴离子通道在心血管疾病中的研究进展[J]. 临床心血管病杂志, 2022, 38(3): 253-257. https://lcxxg.whuhzzs.com/article/doi/10.13201/j.issn.1001-1439.2022.03.017
[17] Okada Y, Okada T, Sato-Numata K, et al. Cell Volume-Activated and Volume-Correlated Anion Channels in Mammalian Cells: Their Biophysical, Molecular, and Pharmacological Properties[J]. Pharmacol Rev, 2019, 71(1): 49-88. doi: 10.1124/pr.118.015917
[18] Berg DD, Vaduganathan M, Upadhyay GA, et al. Cardiac Implantable Electronic Devices in Patients With Left Ventricular Assist Systems[J]. J Am Coll Cardiol, 2018, 71(13): 1483-1493. doi: 10.1016/j.jacc.2018.01.061
[19] 施怡声, 牛丽莉, 朱振辉, 等. 经胸超声心动图在左心室辅助装置置入术围手术期中的应用[J]. 中华心血管病杂志, 2021, 49(6): 610-614.
[20] Drakos SG, Terrovitis JV, Nanas JN, et al. Reverse electrophysiologic remodeling after cardiac mechanical unloading for end-stage nonischemic cardiomyopathy[J]. Ann Thorac Surg, 2011, 91(3): 764-769. doi: 10.1016/j.athoracsur.2010.10.091
[21] Pham BN, Chaparro SV. Left ventricular assist device recovery: does duration of mechanical support matter?[J]. Heart Fail Rev, 2019, 24(2): 237-244. doi: 10.1007/s10741-018-9744-6
[22] Dandel M, Hetzer R. Recovery of failing hearts by mechanical unloading: Pathophysiologic insights and clinical relevance[J]. Am Heart J, 2018, 206: 30-50. doi: 10.1016/j.ahj.2018.09.004
[23] Alexander C, Bishop MJ, Gilchrist RJ, et al. Initiation of ventricular arrhythmia in the acquired long QT syndrome[J]. Cardiovasc Res, 2023, 119(2): 465-476. doi: 10.1093/cvr/cvac103
[24] Krahn AD, Laksman Z, Sy RW, et al. Congenital Long QT Syndrome[J]. JACC Clinical electrophysiol, 2022, 8(5): 687-706. doi: 10.1016/j.jacep.2022.02.017
[25] Ahmed A, Amin M, Boilson BA, et al. Ventricular Arrhythmias in Patients With Left Ventricular Assist Device(LVAD)[J]. Curr Treat Options Cardiovasc Med, 2019, 21(11): 75. doi: 10.1007/s11936-019-0783-7
-
计量
- 文章访问数: 297
- 施引文献: 0