论文部分内容阅读
目的探讨电生理标测冠状静脉窦(CS)分支最延迟电激动处植入左室导线行心脏再同步治疗(CRT)。方法 10例中重度心力衰竭患者,均满足NYHA心功能Ⅲ～Ⅳ级,左室射血分数(LVEF)<0.35且QRS波时限≥120 ms。CRT术中在可植入左室导线的CS分支内进行电生理标测,将标测的最延迟心室电激动处作为左室导线的植入部位,观察该方法的可行性及临床疗效。结果 10例中,扩张型心肌病7例,缺血性心脏病3例;7例为窦性心律,3例为心房颤动;9例ECG表现为左束支传导阻滞,1例为室内传导阻滞。对10例的28个可作为左室导线植入部位的CS分支进行了电生理标测,10例均成功将左室导线植入在标测的最延迟电激动处,该处局部电位较体表ECG的QRS波起始延迟116±28 ms。术后即刻QRS波时限为121±17 ms,比术前153±30 ms明显缩短,P<0.01。8例CRT术后随访时间超过3个月,均有CRT应答(8/8,100%),其中3例超应答(3/8,37.5%),另外1例缺血性心肌病患者CRT术后2个月死于急性前壁心肌梗死;8例CRT应答患者NYHA心功能分级、6 min步行距离、LVEF值、左室收缩末容积、二尖瓣返流速度均较术前明显改善(1.6±0.5级vs 3.3±0.5级;405±92 m vs 307±82m;0.42±0.06 vs 0.30±0.04;121±38 ml vs 153±44 ml;3.9±1.2 m/s vs 4.5±1.5 m/s,P均<0.01)。结论电生理标测指引CS分支最延迟电激动处植入左室导线的CRT方法可行且短期疗效明显。
OBJECTIVE: To investigate the cardiac resynchronization therapy (CRT) for left ventricular lead implantation in the most delayed electrical activation of the coronary sinus (CS) branch electrophysiologically. Methods All 10 patients with moderate-to-severe heart failure satisfied NYHA functional class Ⅲ ~ Ⅳ, left ventricular ejection fraction (LVEF) <0.35 and QRS wave duration ≥120 ms. Electrophysiological mapping was performed in the CS branches of the left ventricular lead implantable during CRT. The most delayed ventricular electrophysiological localization was used as the implantation site of the left ventricular lead. The feasibility and clinical efficacy of this method were observed. Results Of the 10 cases, 7 were dilated cardiomyopathy, 3 were ischemic heart disease, 7 were sinus rhythm, 3 were atrial fibrillation, 9 were left bundle branch block, and 1 was ventricular conduction Blocking. Eighteen CSs, which can be used as the site of implantation for left ventricular conduction, were electrophysiologically mapped in 10 patients. All 10 patients were successfully implanted with the left ventricular lead at the most delayed electrical activation of the labeled site, where the local potential was The ECG QRS wave initial delay 116 ± 28 ms. The postoperative QRS wave duration was 121 ± 17 ms, significantly shorter than that of 153 ± 30 ms preoperatively (P <0.01). The follow-up time of more than 3 months after CRT was CRT (8/8, 100%) 3 cases had hypersensitivity (3/8, 37.5%). Another 1 patient with ischemic cardiomyopathy died of acute anterior myocardial infarction 2 months after CRT. NYHA functional class was graded in 8 patients with CRT, 6 min walking distance , LVEF, left ventricular end-systolic volume and mitral regurgitation were significantly improved compared with those before operation (1.6 ± 0.5 vs 3.3 ± 0.5; 405 ± 92 m vs 307 ± 82 m; 0.42 ± 0.06 vs 0.30 ± 0.04; 121 ± 38 ml vs 153 ± 44 ml; 3.9 ± 1.2 m / s vs 4.5 ± 1.5 m / s, P <0.01). Conclusion The electrophysiological mapping is feasible and short-term curative effect of CRT guided by the most delayed electrical activation of CS branch in left ventricular lead.