靠右心室起搏的婴儿产生了双心室起搏由此导致了心力衰竭病例（英文）

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1、TCYungPaediatricCardiologyUnitGranthamHospitalHongKongBiventricularpacinginababywithRVpacinginducedheartfailureThe10thSouthChinaInternationalCongressofCardiology,Guangzhou,2008MalebabyAntenatalat21weekofgestationnotedhavebradycardiaandAVblockmotherantiRo,RF+veLSCSat35weeksforpr

2、ogressivefetalheartfailure,birthweight2.36kgPost-natalRespiratorydistressCXR:cardiomegaly,CTratio67%PutonnasalCPAP+IsoprenalineinfusionCTratio67%TransfertoTGHonthedayofbirthEchoshowednormalheartstructure,LVSF38.9%,LVEDD2.78cmLVEF77.2%HR~50-60/min,systolicBP55mmHgwhileonisoprena

3、lineinfusionEpicardialpacemakerinsertiontheseconddayafteradmissionRARV(inferiorwall)pacingDDD(90-180/min)PostepicardialDDDpacing:CTratio67.9%MeasurementatOperationLeads4965steroid-elutedleadsforbothRAandRVGenerator-SensiaSEDR01DDDRImpedance-Vlead589Ω-Alead343ΩApacingthreshold-1

4、.8V0.5msVpacingthreshold-1.6V0.5msRwave8.8mvPwave3.4mvParadoxicalseptalmotion,LVEDD2.1cm,FS25.3%,LVEF58%3daysafterRVpacingECHOpostDDDpacing:ECHObeforeDDDpacing:PericardialeffusionShortaxisviewLongaxisviewDay12postpacingSurgicaldrainageofpericardialfluid(30cc)LVEDD2.76cm,FS14.6%

5、,EF37.8%DilatedLVcavity3weekspostpacingDischargefromhospitalwithdiureticsPacingrate70-180/min3.5monthspostRVpacingSignificantheartfailuresymptom:tachypneaandfluidretentionEcho-dilatedLV,LVEDD3.3cm-ModeratetricuspidandmitralincompetencePoorLVcontraction,LVFS5%LVEF14.3%ECGshowedi

6、rregularrhythm,WenckebachphenomenonduetorapidatrialratewhileonDDDpacingPacemodechangedtoVVI130/minHospitalizedfordobutamineinfusionECHOprogressiveLVdilatationSevereLVdysynchrony,LVPW–Septaldelay255ms3daysafteradmissionWhenVVIturnedoffintrinsicescaperhythm,synchronizedLVcontrac

7、tionpacingrateto55/minandstartedisoprenalinetopromotesynchronizedcontraction,ButheartfailurecontinuedtodeteriorateThebabywasintubatedfor5daysRVpacingratewasincreasedto120/minPlanBiventricularepicardialpacingLVepicardialpacingLVleadthreshold=1.0v,0.4msRV/LVdelay=4ms(LVfirst)1d

8、ayafterbiventricularpacingPostbiventpacingLVPW–Septald