跳到主要內容

臺灣博碩士論文加值系統

(3.235.227.117) 您好!臺灣時間:2021/08/01 23:17
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:魏日華
研究生(外文):Jih-Hua Wei
論文名稱:永久性心臟節律器置入病人心室中膈部位電刺激四周後對生物標記的影響
論文名稱(外文):Effects of septal pacing on biomarkers in Patients with Permanent Pacemaker Implantation after 4 weeks
指導教授:林幸榮林幸榮引用關係
指導教授(外文):Sing-Jong Lin
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:臨床醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:41
中文關鍵詞:激動部位生物標記節律器
外文關鍵詞:pacing sitebiomarkerpacemaker
相關次數:
  • 被引用被引用:0
  • 點閱點閱:382
  • 評分評分:
  • 下載下載:46
  • 收藏至我的研究室書目清單書目收藏:0
目的:
我們在永久性心臟節律器置入的病人當中,比較右心室心尖部位及心室中膈部位激動對生物標記的變化。
背景:永久性心臟節律器置入的病人當中,傳統心尖及新式心室中膈部位激動對發炎反應生物標記的變化仍然不清楚。

方法:我們將42位將進行永久性心臟節律器置入的病人前瞻性地分為兩組,當中心尖部位激動組有30位及心室中膈激動組有12位。基礎血清蒐集後將病人的心室搏動速率提升至每分鐘70下,待一個月後以同樣方式再抽血一次進行分析。並進行組內及組間的比較。初級實驗終點為比較其四周後及基礎生物標記的變化。
結果:在心尖搏動的這一組病人中,TNF-α 及 IL-6 有意義的增加 (p值分別為0.001 and 0.03). 而其他包括IL-6、ADMA、及BNP的變化則不明顯。在心室中膈激動的這一組病人中,TNF-α 明顯的增加(p=0.03) 而其他包括hsCRP、IL-6、ADMA、及BNP的變化則仍然不明顯。在兩組之間的比較部分,在心室中膈激動的這一組病人中BNP及TNF-α的數值明顯的比心尖激動的這一組病人來的低(p值分別為0.03 and 0.01)。

結論
比較傳統心尖及新式心室中膈激動對發炎反應的生物標記影響,在經過四周的加強搏動之後,我們發現到心室中膈激動這一組的生物標記BNP及TNF-α的數值相對較心尖部激動這一組的生物標記來得低。未來更大規模、前瞻性、隨機性的臨床試驗是需要的。
OBJECTIVES - We compared changes of serum biomarkers during right ventricular septal (RVSP) and apical pacing (RVAP) in patients with permanent pacemakers.
BACKGROUD - Conventional right ventricular apical pacing might be detrimental to left ventricular (LV) function. These observated results presumbly because bypass of the His-Purkinje system produces dysynchronous LV contraction. Changes in inflammatory biomarkers between patients with novel right ventricular septal and conventional apical pacing remain unknown.
METHODS - 42 patients undergoing permanent pacemaker implantation were divided prospectively into 2 groups with RV apical pacing (RVAP group, n=30) or RV septal pacing (RVSP group, n=12). Baseline serum was collected for biomarkers then the lower pacing rate was programmed up to 70BPM for each patient. After 4 weeks of pacing, the compared serum was collected again for analysis. The primary endpoints were the changes of these biomarkers from baseline to four weeks.
RESULTS - In the RVAP patients group, levels of TNF-α and IL-6 were increased statistically significantly (p=0.001 and 0.03). Changes of hsCRP, ADMA, and BNP were not significant. In patients with RVSP, TNF-α level was increased with statistical significance (p=0.03) and changes of hsCRP, IL-6, ADMA, and BNP still remained insignificant. Between the two groups, the BNP and TNF-α levels of RVSP patients were significantly lower as compared to RVAP patients (p=0.03 and 0.01) at the end of the study.
CONCLUSIONS - Compared the conventional RVAP of permanent pacemakers with novel RVSP, this study demonstrates lower levels of BNP and TNF-α of septal pacing at the end of the study after 4 weeks (p<0.05). Further large-scale, prospective, randomized clinical trials are needed.
English Abstract••••••••••••••••••••••••••6
Chinese Abstract••••••••••••••••••••••••••8
List of Abbreviations••••••••••••••••••••••••10
1. Introduction••••••••••••••••••••••••••11
1.1. Pathophysiologic changes in right ventricular apical pacing••12
1.2. Alternative site pacing in right ventricle•••••••••••12
1.3. Clinical trials for permanent pacemaker and implantable cardioverter-defibrillator•••••••••••••••••13
1.4. Aims of study protocol•••••••••••••••••••14
2. Materials and Methods•••••••••••••••••••••15
2.1. Patient selection••••••••••••••••••••••16
2.2. Study protocol•••••••••••••••••••••••16
2.3. Ventricular lead implantation technique••••••••••••16
2.4. Laboratory measurement••••••••••••••••••18
2.5. Statistical analysis •••••••••••••••••••••18
3. Results••••••••••••••••••••••••••••20
3.1. Demographic data•••••••••••••••••••••21
3.2. Statistical analysis•••••••••••••••••••••••••21
3.2.1. Within group•••••••••••••••••••••21
3.2.2. Between groups••••••••••••••••••••21
3.2.3. ANOVA •••••••••••••••••••••••22
4. Discussion•••••••••••••••••••••••••••23
4.1. Main results •••••••••••••••••••••••24
4.2. Mixed clinical results••••••••••••••••••••24
4.3. Historical reviews of long term outcomes in patients with septal pacing••••••••••••••••••••••••••24
4.4. True pacing septally or elsewhere in RVOT? •••••••••26
4.5. Confirm RVOT septal pacing••••••••••••••••27
5. Limitations•••••••••••••••••••••••••••29
6. Conclusion•••••••••••••••••••••••••••30
7. References ••••••••••••••••••••••••••32
8. Figures and Tables•••••••••••••••••••••••36
1. Sweeny MO, Ellenbogen KA, Casavant D, et al. Multicenter, Prospective, Randomized Safety and Efficacy Study of a New Atrial-Based Managed Ventricular Pacing Mode (MVP) in Dual Chamber ICDs. J Cardiovasc Electrophysiol 2005;16:811-7.
2. Tantengco MVT, Thomas RL, Karpawich PP. Left ventricular dysfunction after long-term right vent-ricular apical pacing in the young. J Am Coll Cardiol 2001;37:2093-100.
3. Sweeney MO, Hellkamp AS, Ellenbogen KA, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 2003;107:2932-7.
4. Tse HF, Lau CP. Long-term effect of right ventricular pacing on myocardial perfusion and function. J Am Coll Cardiol 1997;29:744-9.
5. Cock CC, Giudici MC, Twisk JW. Comparison of the haemodynamic effects of right ventricular outflow-tract pacing with right ventricular apex pacing: a quantitative review. Europace 2003;5:275-8.
6. Stambler BS, Ellenbogen K, Zhang X, et al. Right ventricular outflow versus apical pacing in pacemaker patients with congestive heart failure and atrial fibrillation. J Cardiovasc Electrophysiol 2003;14:1180-6.
7. Scherlag BJ, Helfant RH, Damato AN. A technique for ventricular pacing from the His bundle of the intact heart. J Appl Physiol 1967;22:584-9.
8. Lieberman R, Padelete L, Schreuder J, et al. Ventricular pacing lead location alters systemic hemodynamics and left ventricular function in patients with and without reduced ejection fraction. J Am Coll Cardiol 2006;48:1634-41.
9. Lamas GA, Lee KL, Sweeney MO, et al. Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. N Engl J Med 2002;346:1854-62.
10. Link MS, Hellkamp AS, Estes III NAM, et al., for the MOST Study Investigators. High incidence of pacemaker syndrome in patients with sinus node dysfunction treated with ventricular-based pacing in the Mode Selection Trial (MOST). J Am Coll Cardiol 2004;43:2066-71.
11. Lamas GA, Orav J, Stambler BS, et al. Quality of life and clinical outcomes in elderly patients treated with ventricular pacing as compared with dual-chamber pacing. N Engl J Med 1998;338:1097-104.
12. Andersen HR, Thuesen L, Bagger JP, et al. Prospective randomized trials of atrial versus ventricular pacing in sick sinus syndrome. Lancet 1994;344:1523-8.
13. Andersen HR, Nielsen JC, Thomsen PE, et al. Long-term follow-up of patients from a randomized trial of atrial versus ventricular pacing for sick sinus syndrome. Lancet 1997;350:1210-6.
14. Nielsen JC, Andersen HR, Thomsen PE, et al. Heart failure and echocardiographic changes during long-term follow-up of patients with sick sinus syndrome randomized to single chamber atrial or ventricular pacing. Circulation 1998;97:987-95.
15. Nielsen JC, Kristensen L, Andersen HR, Mortensen PT, Pedersen OL, Pedersen AK. A randomized comparison of atrial and dual chamber pacing in 177 consecutive patients with sick sinus syndrome: echocardiographic and clinical outcome. J Am Coll Cardiol 2003;42: 614-23.
16. Andersen HR, Nielsen JC. Pacing in sick sinus syndrome—need for a prospective, randomized trial comparing atrial with dual chamber pacing. Pacing Clin Electrophysiol 1998;21:1175-9.
17. Connolly SJ, Kerr CR, Gent M, et al. Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. Canadian Trial of Physiologic Pacing Investigators. N Engl J Med 2000;342:1385-91.
18. Kerr CR, Connolly SJ, Abdollah H, et al. Canadian Trial of physiological pacing effects of physiologic pacing during long-term follow-up. Circulation. 2004;109:357-362.
19. Kristensen L, Nielsen JC, Pedersen AK, Mortensen PT, Andersen HR. AV block and changes in pacing mode during long-term follow-up of 399 consecutive patients with sick sinus syndrome treated with an AAI/AAIR pacemaker. Pacing Clin Electrophysiol 2001;24: 358-65.
20. Toff WD, Camm AJ, Skehan JD, for the United Kingdom Pacing and Cardiovascular Events Trial (UKPACE) Investigators. Single-chamber versus dual-chamber pacing for high-grade atrioventricular block. N Engl J Med 2005;353:145-55.
21. Wilkoff BL, Cook JR, Epstein AE, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 2002; 288:3115-23.
22. Steinberg JS, Fischer A, Wang P, et al. The clinical implications of cumulative right ventricular pacing in the multicenter automatic defibrillator (MADIT) trial II. J Cardiovasc Electrophysiol 2005; 16:359-365.
23. Marketou ME, Simantirakis EN, Nikitovic D, Chrysostomakis SI, Zacharis EA, Vardas PE. Impact of asynchronous ventricular activation on proinflammatory cytokines and oxidative stress in paced patients. Heart 2005;91:817-818.
24. Kypta A, Steinwender C, Kammler J, Leisch F, Hofmann R. Long-term outcomes in patients with atrioventricular block undergoing septal ventricular lead implantation compared with standard apical pacing. Europace 2008;10:574-579.
25. Seta Y, Shan K, Bozkurt B, Oral H, Mann DL. Basic Mechanisms in Heart Failure: The Cytokine Hypothesis. Journal of Cardiac Failure 1996; 2:243-249.
26. Yin WS, Chen JW, Jen HL, et al. Independent prognostic value of elevated high sensitivity C-reactive protein in chronic heart failure. Am Heart J 2004;147:931-8.
27. Deswal A, Petersen NJ, Feldman AM, Young JB, White BG, Mann DL. Cytokines and Cytokine Receptors in Advanced Heart Failure An Analysis of the Cytokine Database from the Vesnarinone Trial (VEST). Circulation 2001;103:2055-9.
28. Ohnishi M, Wada A, Tsutamoto T, et al. Endothelin stimulates an endogenous nitric oxide synthase inhibitor, asymmetric dimethylarginine, in experimental heart failure. Clin Sci (Lond). 2002;103,Suppl 48:241S-244S.
29. Hillock RJ, Stevenson IH, Mond HG. The Right ventricular outflow tract: A comparative study of septal, anterior wall, and free wall pacing. PACE. 2007:30:942-947
30. Mond HG, Hillock RJ, Stevenson IH, McGavigan AD. The Right Ventricular Outflow tract: The road to septal pacing. PACE 2007; 30:482-491
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top