인공 심박동기 환자에서 심실동기이상의 관련인자
The factors influencing ventricular dyssynchrony in patients with permanent pacemaker
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목적: 최근 여러 연구에서 장기적인 우심실 조율은 심실동기이상을 야기하여 심기능을 저하시키고 사망률을 증가시키는 것으로 알려져 있다. 심실동기이상은 기저질환, 조율 방식, 조율 장소 등에 의해서 달라질 것으로 생각되어 본 연구에서는 조율 방식, 심실 조율 정도, 조율 심전도(QRS 형태, 폭, 재분극 이상), 심실 조율 기간, 혈청학적 표지자 등과 심실동기이상과의 관계를 규명하고자 하였다. 방법: 1991년 1월부터 2008년 3월까지 인공 심박동기를 이식받은 후 정기적으로 외래에서 추적관찰 중인 환자들 가운데 139명(남:여=1:1.35, 66.8±1.0년)을 대상으로 시행하였다. 심전도, 심초음파도, 심박동기 기능 분석과 혈청 표지자 검사를 같은 날에 시행하였다. 심장 초음파로 심실동기이상을 평가하여, 심실동기이상이 없는 환자를 대조군 있는 환자를 동기이상 군으로 분류하여 임상적 특징 및 심전도, 혈청 표지자를 비교하였다. 결과: 심실동기이상은 인공 심박동기를 삽입한 환자의 71.9%에서 나타났으며, 나이와 성별, 기저질환, 조율기간과의 관계는 보이지 않았으나 방실 전도차단 및 심실 조율 환자에서 더 흔하게 동반되었다. 심전도에서 QRS폭의 연장, 교정 QT간격의 연장 등과 연관이 있었다. 심초음파도 검사에서 삼첨판막 역류증과 연관이 있었고, 혈청 NT pro-BNP가 유의하게 높았다. 결론: 영구형 인공 심박동기 이식 환자에서 심실동기이상은 주로 방실 전도 차단 및 심실 조율 환자에게 심박동기를 삽입하였을 때 주로 나타났다. 심전도상의 조율 QRS파의 폭, 교정 QT 간격의 증가 및 심초음파도에서 삼첨판막 역류증, 혈청 pro-BNP상승이 관련인자로 사용할 수 있을 것으로 생각되었다.
Abstract
Background/Aims: Chronic right ventricular pacing (RVP) can lead to increased risks of ventricular dyssynchrony (VD), heart failure, and mortality. This study examined the factors influencing VD in patients treated with a permanent pacemaker (PPM). Methods: The study enrolled 139 patients (M:F=1:1.35, 66.8±1.0 years) who had permanent pacemaker implanted [AAI (R): 11, VVI (R): 39, VDD (R): 50, DDD: 39]. Their clinical characteristics, 12-lead electrocardiogram (ECG), echocardiography, and laboratory parameters were evaluated. The patients were divided into two groups according to the presence of VD. Results: VD was seen in 71.9% of the patients with a PPM. No significant difference was observed in the clinical characteristics, except for the indications and current action mode of the PPM. VD was more frequently associated with patients with AV block and ventricular pacing. The QRS duration and QTc interval were significantly wider in patients with VD (159.9±3.2 vs. 129.4±6.3 ms, p<0.001; 487.7±4.0 vs. 470.9±8.0 ms, p<0.05, respectively). On echocardiography, tricuspid regurgitation was more common in patients with VD. The N-terminal B-type natriuretic peptide (NT-proBNP) level was higher in the dyssynchrony group (431.4±66.1 vs. 202.8±40.8, p<0.05). Conclusions: Patients with AV block and ventricular pacing developed VD more frequently. A higher serum NT-proBNP level and prolonged QRS duration, QTc, and tricuspid regurgitation might be associated with VD.
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