双心室起搏兼顾房室结优先使QRS波进一步变窄的研究

目的：探索在接受抗心衰起搏治疗的患者中,通过双室起搏兼顾房室结优先,力求QRS波进一步变窄的可能性和方法学。方法：选取2008年5月～2012年12月入选昆明医科大学一附院心内科收住入院,确诊为慢性充血性心力衰竭、有CRT-P/D适应证并成功植入抗心衰三腔起搏器的患者60例(男47例、女13例、平均年龄63.87±9.29岁)。术后随访期内,所有患者均分别给予双室起搏兼顾房室结优先和传统双室起搏两种CRT工作模式。比较兼顾模式和传统模式在心电图QRS波宽度上的差异。结果：60例患者的CRT系统在静息状态下,均可借助程控仪和12导体表心电图监测,实现传统和兼顾两种CRT工作模式(成功率100%)。且两种CRT工作模式的QRS波平均宽度均分别小于CRT术前(115.78±19.30ms和137.03±19.76ms与155.72±28.78ms,P均<0.01)。静息状态下,兼顾模式的QRS波平均宽畸程度低于传统模式,QRS波平均时限短于传统模式(115.78±19.30ms与137.03±19.76ms,P<0.01)。兼顾模式的QRS波平均宽度较传统模式减少15.5%。结论：传统CRT工作模式强调100%双室起搏夺获,弃用自身房室传导,造成QRS波偏宽畸,可能是部分患者对CRT无应答的原因之一。

The research of Maintaining atrioventricular intrinsic conduction during cardiac resynchronization therapy can get the further narrowing of the QRS complex

Objective: To explore in the patients with heart failure pacemaker therapy, by double chamber pacemaker to two or morethings atrioventricular node first, strive for the possibility of further narrow QRS wave and methodology. Methods: In May 2008 to December 2012 in kunming medical university heart admitted to the hospital, with a diagnosis of chronic congestive heart failure, the CRT - P/D indications and successfully implanted pacemaker of 60 cases of patients with heart failure three Chambers 47 cases (male, female 13 cases, mean age 63.87 / - 9.29 years). Postoperative follow-up period, all patients were given double chamber pacemaker atrioventricular node priority and give attention to two or morethings traditional dual chamber pacing, two kinds of CRT work mode. Compared to two or morethings mode and traditional mode of differences is in electrocardiogram QRS wave width. Results: 60 patients with CRT system in the resting state, all can with the aid of program-controlled apparatus and 12 conductor table ecg monitoring, implementation mode and both two kinds of CRT success rate (100%). And two kinds of operation modes of the CRT QRS wave are respectively the average width less than the CRT preoperative (115.78 19.30 / - 19.76 ms and 137.03 ms and 155.72 / - 28.78 ms, P < 0.01). Resting state, the combining pattern of wide QRS wave average abnormal degree is lower than the traditional model, QRS wave of average time limit short traditional mode (115.78 / - 19.30 ms and 19.30 / - 19.76 ms, P < 0.01). Both the average width than traditional mode of QRS wave model is reduced by 15.5%. Conclusion: The traditional CRT work mode emphasizes, dual chamber pacing, took 100%, abandoned their atrioventricular conduction, wide QRS wave caused by partial abnormal, could be a part of patients to the CRT is one of the reasons for no answer.