CRT-D在慢性心力衰竭患者的临床应用

目的 心脏再同步治疗（CRT）可以显著改善慢性心力衰竭（CHF）患者心功能,而植入型心律转复除颤器（ICD）可以有效预防心脏性猝死.具有CRT和ICD功能的CRT-D已开始应用于临床.本文初步总结CRT-D的临床应用.方法 4例药物治疗无效的CHF患者,合并左束支阻滞、左心室舒张末内径增大,而且既往有室性心动过速病史.其中扩张性心肌病3例,缺血性心肌病1例.接受组织多普勒检查证实存在心脏运动不同步后,接受了CRT-D治疗.结果 4例患者均成功植入CRT-D.左心室起搏导线植入到心脏后静脉3例,心脏侧后静脉1例.术中测试除颤能量≤20 J,无并发症发生.术后1周左心室射血分数从0.34增加至0.42。结论 CRT-D植入技术难度大,风险高,但其安全性肯定.鉴于其显著疗效,建议同时满足CRT和ICD适应证的患者应该接受CRT-D治疗.

The clinical application of CRT-D in patients with chronic heart failure

Objective Cardiac resynchronization therapy (CRT) is a new approach for the treatment of patients with chronic heart failure and has been associated with improved cardiac function, while implantable cardioverter defibrillator (ICD) can effectively prevent sudden cardiac death. Nowadays, cardiac resynchronization therapy-defibrillator (CRT-D) has been used clinically. In this study, we aimed to summaries the clinical application of CRT-D.Methods Four drug-resistant heart failure patients with the history of ventricular tachycardia were enrolled. Three of them had dilated cardiomyopathy and 1 had ischemic cardiomyopathy. They were all with left ventricular bundle branch block, enlarged left ventricle and cardiac dyssynchrony confirmed by tissue Doppler imaging. All of them were attempted to implant CRT-D.Results All patients were successfully implanted with CRT-D. The left ventricle lead positioned in an epicardial cardiac vein as follows: posterior in 3 and posterolateral in 1. The defibrillation thresholds were no more than 20 J and no complications occurred.One week after CRT-D implantation, the left ventricular ejection fraction increased from 0.34 to 0.42.ConclusionsAlthough the implantation of CRT-D is rather complicated with some potential of complications, yet it is still feasible and safe. Based on the significant effects, patients with the indication for CRT and ICD have to receive CRT-D.