[Percutaneous coronary intervention combined cardiac resynchronization therapy for refractory heart failure secondary to ischemic cardiomyopathy].
OBJECTIVE
To evaluate the efficacy and safety of percutaneous coronary intervention (PCI) combined cardiac resynchronization therapy (CRT) for refractory heart failure secondary to ischemic cardiomyopathy (ICM).


METHODS
PCI and CRT were performed in 7 ICM patients confirmed by angiography with NYHA class IV, QRS duration >/= 130 ms in 6 of them, III degrees AVB in 1 patient, fast ventricular heart rate Af in 1 patient, ventricular fibrillation history in 2 patient. All of them had their LVEDD >/= 55 mm, and LVEF </= 0.40 detected by UCG. PCI was performed first in 5 patients, and their follow-up angiography showed no restenosis 6 months after PCI, then CRT was given. CRT was performed first in 2 patients and 2 weeks later PCI was combined.


RESULTS
The procedures of PCI and CRT were performed successfully in all patients. Five patients received right atrial and biventricular pacing, one patient with Af received biventricular pacing and atrial-ventricular node radiofrequency ablation at the same procedure, and the another one patient received CRTD. One out of seven patients died of re-AMI 4 months after the combination therapy, and the other 6 patients had been alive 5 - 41 (23.2 +/- 13.8) months during the follow-up period. The heart function of the 7 patients had further improved after PCI and CRT combined therapy compared to that of PCI or CRT only. Their NYHA class decreased from IV to II, 6-minute walking distance increased steadily, and mitral regurgitation reduced and QRS duration shortened significantly. The LVEDD decreased and LVEF increased significantly in 2 patients without ventricular aneurysm, and slight improvement or no change were in the other 5 patients.


CONCLUSIONS
For patients with refractory heart failure secondary to ICM, the combination of PCI and CRT could obviously improve their heart function, quality of life and prognosis, which also very safe in perforation.
Han
Ya-ling
YL
Department of Cardiology, Shenyang General Hospital of PLA, Shenyang 110016, China.
Zang
Hong-yun
HY
Wang
Dong-mei
DM
Jing
Quan-min
QM
Wang
Shou-li
SL
Wang
Zu-lu
ZL
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome