心电图在CRT治疗VV间期优化中的应用

目的比较心脏再同步治疗(CRT)VV间期的超声心动图优化方法与心电图优化方法的相关性。方法入选36例CRT植入术后大于3个月的病例,选择左室领先30ms、双室同步、右室领先30ms、60ms5种VV间期,用超声心动图VTI替代每搏输出量,并设立相应VV间期为最佳VV间期。两种心电图优化方法同时进行。第1种为QRS波时限法:描记出最窄QRS波为最佳VV间期。第2种为心室间激动延迟法:即分别在胸前导联(最好V1或V2导联)记录从起搏信号到QRS波形态最早出现变化的间期,仅左室起搏时所获得的间期记为T1,仅右室起搏时获得的间期记为T2。T2-T1代表最佳VV间期。结果超声优化的最佳VV间期左室领先为负值,左室与在后第1种心电图优化方法与VTI符合率64%(r=0.61,p<0.01);第2种心电图优化方法符合率为86%(r=0.82,p<0.001);联合上述两种心电图方法,其符合率达92%(r=0.90,p<0.0001)结论 CRT的VV间期优化中,与超声心动图优化对比,联合两种心电图方法其相关性最高。

The effect of the surface electrocardiographic in interventricular delay interval optimization in cardiac resynchronization therapy

Objective To correlate the optimal VV pacing interval obtained by echo with the optimal VV interval obtained by two methods based on the surface ECG. Methods Thirty six patients with a cardiac resynchronization therapy device for >3 months were enrolled. VV optimization was performed by measuring the aortic velocity time integral(VTI). Five VV intervals were tested, LV preactivation at -30ms, -60ms, simultaneous biventricular pacing(0ms), and RV preactivation at +30 ms, +60 ms. The one that achieved the highest VTI was chosen as the optimal VV. Results The results were performed by two different ECG measurements. The first ECG method considered the best VV to be that which achieved the narrowest QRS. The second VV method consisted in measuring the interval from the pacing spike to the beginning of the fast deflexion of the QRS complex in leads V1, V2, first pacing from the LV(T1), and after from the RV(T2). The T2-T1 interval was considered as a surrogate measurement of VV delay and defined as the best VV. Optimal VV interval obtained by echo was–60 ms in 8 patients(22%), –30ms in 16 patients(45%), +30 ms in 3 patients (8%), +60 ms in 1 patient(3%) and 0ms in the remaining 8 patients (22%). Echo results had 64% coincidence with the first ECG method(r=0.61, p<0.01) and 86% coincidence with the second ECG method(r=0.82, p<0.001). Furthermore, 92% coincidence with both the two ECG methods(r=0.90, p<0.0001). Conclusions Combimed with the two different ECG methods could get a good correlation with the VV optimization chosen according to echo.