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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >Pacing-induced electrophysiological remodeling in hypertrophic obstructive cardiomyopathy--observations on cardiac memory.
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Pacing-induced electrophysiological remodeling in hypertrophic obstructive cardiomyopathy--observations on cardiac memory.

机译：肥厚性梗阻性心肌病起搏诱导的电生理重塑-心脏记忆的观察。

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BACKGROUND: Hypertrophic cardiomyopathy carries an increased risk for sudden cardiac death. While pacing therapy reduces the left ventricular outflow tract gradient and improves symptoms in a subgroup of hypertrophic obstructive cardiomyopathy (HOCM) patients, its electrophysiological consequences are unknown and were therefore assessed in this prospective study. METHODS AND RESULTS: Fifteen consecutive HOCM patients were studied and compared with 14 patients without HOCM paced because of sinus bradycardia. ECG intervals were measured before pacemaker implantation and after > or =3 months of DDD pacing in HOCM patients and > or =5 weeks in controls. Both groups showed similar ECG signs of cardiac memory development. In HOCM patients, with baseline QTc 447 +/- 33 ms, cardiac memory development was not associated with any significant changes in ECG intervals. In contrast, baseline repolarization in control patients was significantly prolonged by 6% (QTc 429 +/- 33 vs 454 +/- 46 ms; P < 0.05). Furthermore, in HOCM patients repolarization was 7% shorter during DDD pacing compared to sinus rhythm (JTc 329 +/- 25 vs 353 +/- 21 ms; P < 0.05), despite a significantly prolonged ventricular activation time (QRS duration 155 +/- 16 vs 91 +/- 9 ms; P < 0.01). CONCLUSIONS: Importantly, the development of cardiac memory-induced different repolarization responses depending on baseline structure and electrophysiology. In HOCM patients repolarization was shorter during right ventricular apical pacing than during normal activation despite prolonged activation time.
机译：背景：肥厚型心肌病会增加心脏猝死的风险。起搏疗法可减少肥厚性梗阻性心肌病（HOCM）患者亚组的左心室流出道梯度并改善症状，但其电生理后果尚不清楚，因此在此前瞻性研究中进行了评估。方法与结果：连续研究了15例HOCM患者，并将其与14例因窦性心动过缓而没有HOCM起搏的患者进行了比较。在起搏器植入前，HOCM患者≥3个月DDD起搏和对照组≥5周后测量ECG间隔。两组均显示出类似的心电图心脏记忆发育。在基线QTc为447 +/- 33 ms的HOCM患者中，心脏记忆的发展与ECG间隔的任何显着变化无关。相反，对照组患者的基线复极明显延长了6％（QTc 429 +/- 33 vs 454 +/- 46 ms; P <0.05）。此外，尽管心室激活时间明显延长（QRS持续时间155 + /），但在HOCM患者中，与窦性心律相比，DDD起搏期间的复极时间缩短了7％（JTc 329 +/- 25 vs 353 +/- 21 ms; P <0.05）。 -16 vs 91 +/- 9毫秒; P <0.01）。结论：重要的是，取决于基线结构和电生理，心脏记忆诱发的不同的复极化反应的发展。在HOCM患者中，尽管激活时间延长，但右心室心律起搏期间的复极时间比正常激活时短。

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