心脏再同步治疗术中测试腔内心电图参数的临床意义

目的 探讨心脏再同步治疗（CRT）术中测定腔内心电图参数,尤其是左心室激动延迟时间是否可以预测心力衰竭患者左心室逆重构发生.方法 2009年1月至2013年1月37例完全性左束支阻滞患者在天津市胸科医院心内科植入CRT,术中测试窦性心律自身传导情况下右心室-左心室导线的激动时间差（△t）,测试右心室导线起搏到左心室导线感知时间（RVp-LV）及左心室导线起搏到右心室导线感知时间（LVp-RV）.随访观察1年,比较术前、术后心脏结构变化,以左心室舒张末期容积减小15％或射血分数提高5％为标准分为CRT应答组和无应答组.结果 左心室逆重构的发生与术中测试腔内心电图△t、RVp-LV、LVp-RV等参数均无明显关系,△t与术前QRS时限有关,RVp-LV、LVp-RV在左心室舒张末期内径（LVEDD） ＞75 mm的患者中长于LVEDD≤75 mm的患者（P＜0.05）.左心室导线植入在左心室基底部、中段、心尖部的患者发生左心室逆重构的比例分别为71.4％、90.4％、12.5％,差异有统计学意义（P＜0.05）,3个部位的△t、RVp-LV、LVp-RV差异无统计学意义.结论 术中测定腔内心电图相关参数不能预测CRT是否应答,左心室导线位置仍是决定CRT疗效的关键因素.

Clinical significance of intracardiac electrogram in predicting left ventricular reverse remodeling after cardiac resynchronization therapy

Objective To evaluate the significance of intracardiac electrogram in predicting ventricular remodeling after cardiac resynchronization therapy （CRT）. Methods Thirty-seven subjects with standard indi- cations for CRT underwent intracardiac electrogram measurements and echocardiogram.All the left ventricular （LV） leads were placed in lateral vein.Mter 12 months follow-up, echocardiogram was done again.A reduction of LV end-systolic volume ≥ 15% or improvement of LV ejection fraction 〉t 5% was used to define CRT responders. Results The interval between the onset of right ventricle （RV） lead and LV lead electrograms （At）, the interval between RV pacing and LV sensing （RVp-LV）, the interval between LV pacing and RV sensing（LVp-RV） had no statistic difference between responders and non-responders and had no difference be- tween different LV leads location.The patients with middle segment location of LV leads had higher reverse LV remodeling than patients with apical positioned LV Leads（90.4% vs.12. 5% ,P〈0.05 ）. Conclusions It was LV leads location predict LV reverse remodeling but not intraeardiac electrogram at 12 months after CRT.