靠右心室起搏的嬰兒產(chǎn)生了雙心室起搏由此導(dǎo)致了心力衰竭-病例（英文）課件

1、TC YungPaediatric Cardiology UnitGrantham HospitalHong KongBiventricular pacing in a baby with RV pacing induced heart failureThe 10th South China International Congress of Cardiology, Guangzhou, 2008Male babyAntenatalat 21 week of gestation noted have bradycardia and AV blockmother anti Ro, RF + ve

2、 LSCS at 35 weeks for progressive fetal heart failure, birth weight 2.36 kgPost-natal Respiratory distressCXR : cardiomegaly, CT ratio 67% Put on nasal CPAP + Isoprenaline infusionCT ratio 67%Transfer to TGH on the day of birthEcho showed normal heart structure, LVSF 38.9%, LVEDD 2.78cm LVEF 77.2%HR

3、 50-60/min, systolic BP 55mmHg while on isoprenaline infusionEpicardial pacemaker insertion the second day after admissionRA RV (inferior wall) pacing DDD (90-180/min)Post epicardial DDD pacing: CT ratio 67.9%Measurement at Operation Leads 4965 steroid-eluted leads for both RA and RV Generator-Sensi

4、a SE DR 01 DDDRImpedance - V lead 589 - A lead 343 A pacing threshold - 1.8V 0.5msV pacing threshold - 1.6V 0.5ms R wave8.8mvP wave3.4mvPericardial effusion Short axis viewLong axis viewDay 12 post pacing Surgical drainage of pericardial fluid (30cc)LVEDD 2.76cm, FS 14.6%, EF 37.8% Dilated LV cavity

5、3 weeks post pacingDischarge from hospital with diuretics Pacing rate 70-180/min3 days after admissionWhen VVI turned off intrinsic escape rhythm, synchronized LV contraction pacing rate to 55/min and started isoprenaline to promote synchronized contraction, But heart failure continued to deteriorat

6、eThe baby was intubated for 5 daysRV pacing rate was increased to 120/minPlan Biventricular epicardial pacingLV epicardial pacing LV lead threshold = 1.0 v , 0.4msRV/LV delay = 4ms (LV first)1 day after biventricular pacingPost bivent pacingLVPW Septal delay 65msDDD RV pacing LVPW Septal delay 255ms

7、Second day post biventricular pacingLVEDD 3.24cm, LVSF 20.6%, mild mitral incompetenceBiventricular pacing QRD duration: 100 ms Post epicardial DDD (RA RV ) pacing 90 -180 ppm QRS duration 120 msDDD RV pacing QRS duration: 120 msBiventricular pacing QRD duration: 100 ms 1 week after Bivent pacing Ho

8、me with diuretics and ACEILVEDD 3.19cm, LVSF 20.2% LVEF 49.3%Septal-LVPW delay 65ms10 days after Bivent pacing LVEDD 3.02cm, LVSF 26.7%, LVEF 60.0%17 days after Bivent pacing LVEDD 2.51cm, LVSF 27.8% ,LVEF 62.5%4 weeks post Bivent pacingLVEDD 2.4cm, LVSF 33% LVEF 69.9%3 weeks after Bivent pacing5 mo

9、nths post Bivent pacingLVEDD 2.5cm, LVSF 44% , LVEF 82%no mitral incompetenceOff medication 9 months post biventrcular pacing LVEDD 2.32cm, FS 32.5% LVEF 67.2%LV size and LV ejection fractioncmBivent pacingAdmission for heart failureSummary:RV pacing may occasionally induced severe LV dysfunction secondary to LV dysynchronyLV dysfunction may be evident within 2 weeks after RV pacing and progress to dilated cardiomyopathyBiventricular pacing (CRT) can correct the LV dysynchrony and the dilated cardiomyopathy Post epic