[1]汪汉 蔡琳 邓晓奇 李锦 童琳 刘汉雄.双心室起搏对心力衰竭患者心脏电机械同步性的影响[J].心血管病学进展,2022,(9):860-864.[doi:10.16806/j.cnki.issn.1004-3934.2022.09.020]
 WANG Han,CAI Lin,DENG Xiaoqi,et al.Effect of Biventricular Pacing on Cardiac Electromechanical Synchronization in Patients with Heart Failure[J].Advances in Cardiovascular Diseases,2022,(9):860-864.[doi:10.16806/j.cnki.issn.1004-3934.2022.09.020]
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双心室起搏对心力衰竭患者心脏电机械同步性的影响()
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《心血管病学进展》[ISSN:51-1187/R/CN:1004-3934]

卷:
期数:
2022年9期
页码:
860-864
栏目:
出版日期:
2022-09-25

文章信息/Info

Title:
Effect of Biventricular Pacing on Cardiac Electromechanical Synchronization in Patients with Heart Failure
作者:
汪汉 蔡琳 邓晓奇 李锦 童琳 刘汉雄
(西南交通大学附属医院 成都市心血管病研究所 成都市第三人民医院心内科,四川 成都 610031)
Author(s):
WANG HanCAI LinDENG XiaoqiLI JinTONG LinLIU Hanxiong
(Department of Cardiology,The Affiliated Hospital of Southwest Jiaotong University,The Third People’s Hospital of Chengdu,Cardiovascular Disease Research Institute of Chengdu,Chengdu 610031,Sichuan,China)
关键词:
双心室起搏心力衰竭心脏再同步化治疗心脏电机械同步性
Keywords:
Biventricular pacingHeart failureCardiac resynchronization therapyCardiac electromechanical synchronization
DOI:
10.16806/j.cnki.issn.1004-3934.2022.09.020
摘要:
目的 评估双心室起搏模式对心力衰竭患者心脏电机械同步性的影响,寻找最佳的起搏模式,以指导心脏再同步化治疗 的临床实践。方法 纳入成都市第三人民医院2007年6月—2009年4月准备行心内电生理检查的心力衰竭病例。 标测电极导管于左心室后游离壁、右心室心尖、左心室前间隔和右心室前间隔,通过Ensite Array非接触式标测球囊多电极导管记录电同步性,以彩色多普勒超声诊断仪的向量速度显像记录机械同步性。经方差分析及多重比较分析双心室起搏模式下心力衰竭患者的最佳起搏模式。结果 共纳入受试者20例。电同步性分析显示起搏模式( 右心室前间隔-左心室后游离壁)的QRS波群宽度最窄(P<0.05),且与自身心律QRS波群形态比较统计学上的显著差异最小(P<0.05);机械同步性分析显示起搏模式是影响机械同步性的最重要因素,起搏模式(右心室前间隔-左心室后游离壁)的室壁峰值收缩速度达峰时间的离散度最小,机械同步性最好,且与其他各模式比较其差别有统计学意义(P<0.05)。结论 右心室前间隔-左心室后游离壁可能是心脏再同步化治疗中的最佳起搏模式。
Abstract:
Objective To evaluate the effect of biventricular pacing mode on cardiac electromechanical synchronization in patients with heart failure and to find the best pacing mode in order to guide the clinical practice of cardiac resynchronization therapy. Methods Patients with heart failure who were ready for electrophysiological examination from June 2007 to April 2009 were selected. The electrode catheter was located in the left ventricular posterior free wall,the right ventricular apex,the left ventricular anterior septum and the right ventricular anterior septum. The electrical synchronization was recorded by Ensite Array non-contact mapping balloon multi-electrode catheter,and the mechanical synchronization was recorded by vector velocity imaging of color Doppler ultrasound diagnostic instrument. The best pacing mode in patients with heart failure under biventricular pacing mode was analyzed by analysis of variance and multiple comparison. Results A total of 20 subjects were included. Electrical synchronization analysis showed that the width of QRS wave in pacing mode(right anterior septum-left ventricular posterior free wall) was the narrowest( P<0.05),and there was the least significant difference between pacing mode and self-rhythm QRS morphology(P<0.05). Mechanical synchronization analysis showed that pacing mode was the most important factor affecting mechanical synchrony. The dispersion of peak systolic velocity of ventricular wall reached peak time was the smallest and mechanical synchronization was the best in pacing mode(right anterior ventricular septum-left ventricular posterior free wall). Compared with other models,there was significant difference(P<0.05). Conclusion The pacing mode (right ventricular anterior septum-left ventricular posterior free wall) may be the best pacing mode in cardiac resynchronization therapy.

参考文献/References:

[1]Nakasuka K,Ishibashi K,Kamijima A,et al. Very long-term prognosis in patients with right ventricular apical pacing for sick sinus syndrome[J]. Heart,2019,105(19):1493-1499.

[2]蔡琳,黄德嘉,燕纯伯,等. 心脏选择性部位起搏的电和机械同步性研究的初步报告[J]. 中华心血管病杂志,2007,35(2):147-150.

[3]Abraham WT,Fisher WG,Smith AL. Cardiac resynchronization in chronic heart failure[J]. N Engl J Med,2002,346(24):1845-1853.

[4]Derval N,Bordachar P,Lim HS,et al. Impact of pacing site on QRS duration and its relationship to hemodynamic response in cardiac resynchronization therapy for congestive heart failure[J]. J Cardiovasc Electrophysiol,2014,25(9):1012-1020.

[5]Wong JA,Yee R,Stirrat J,et al. Influence of pacing site characteristics on response to cardiac resynchronization therapy[J]. Circ Cardiovasc Imaging,2013,6(4):542-550.

[6]R?nn F,Kesek M,Karp K,et al. Right ventricular lead positioning does not influence the benefits of cardiac resynchronization therapy in patients with heart failure and atrial fibrillation[J]. Europace,2011,13(12):1747-1752.

[7]Shimano M,Inden Y,Yoshida Y,et al. Does RV lead positioning provide additional benefit to cardiac resynchronization therapy in patients with advanced heart failure?[J]. Pacing Clin Electrophysiol,2006,29(10):1069-1074.

[8]Providencia R,Barra S,Papageorgiou N,et al. Dual-site right ventricular pacing in patients undergoing cardiac resynchronization therapy:results of a multicenter propensity-matched analysis[J]. Pacing Clin Electrophysiol,2017,40(10):1113-1120.

[9]Modi S,Yee R,Scholl D,et al. Ventricular pacing site separation by cardiac computed tomography:validation for the prediction of clinical response to cardiac resynchronization therapy[J]. Int J Cardiovasc Imaging,2017,33(9):1433-1442.

[10]张俊蒙,王泽峰,张健,等. 心力衰竭再同步化治疗新理念:希浦系统起搏心脏再同步化治疗[J]. 中华心力衰竭和心肌病杂志,2019,3(3):159-162.

[11]Zhang B,Guo J,Zhang G. Comparison of triple-site ventricular pacing versus conventional cardiac resynchronization therapy in patients with systolic heart failure:a meta-analysis of randomized and observational studies[J]. J Arrhythm,2017,34(1):55-64.

[12]Zanon F,Marcantoni L,Baracca E,et al. Optimization of left ventricular pacing site plus multipoint pacing improves remodeling and clinical response to cardiac resynchronization therapy at 1 year[J]. Heart Rhythm,2016,13(8):1644-1651.

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备注/Memo

备注/Memo:
收稿日期:2021-08-17
基金项目:中国健康与医疗发展基金会(NCT00918294-2008-zhFj1);成都市“十一五”科技攻关重大专项(07YTYB957SF-020)
更新日期/Last Update: 2022-10-24