优化AV间期和VV间期对提高心脏再同步治疗疗效的评价  

Evaluation of Clinical Effectiveness of Cardiac Resynchronization Therapy Optimized AV Delay and VV Delay

作　　者：李庆勇[1] 汤宝鹏[1] 

机构地区：[1]新疆医科大学第一附属医院心脏中心起搏电生理科,新疆乌鲁木齐830054

出　　处：《心血管病学进展》2008年第B05期1-4,共4页Advances in Cardiovascular Diseases

摘　　要：心脏再同步治疗(CRT)作为一种新治疗心力衰竭的方法,疗效确切,但是心脏再同步-心力衰竭研究(CARE-HF)证实仍然有20%～30%患者对CRT治疗无反应。目前认为提高CRT疗效除了严格适应证选择、左室电极的正确放置外,术后进行房室间期(AV间期)以及心室同步(VV间期)优化是一项重要措施。迄今为止,已经提出很多指导优化程控的方法,如心电图、超声心动图、核素心室显像、磁共振描记成像等。就心电图而言,心电图简单而且在理论上有助于CRT的优化程控,但是忽略了心肌各部位之间的电机械延迟;同心电图相比,超声心动图指标有重要的实践意义,是CRT术后优化程控的有效方法。但是CRT术后优化程控仍然面临重大挑战,最佳AV存在个体差异,而且随着心率的变化而改变,因此个体化的动态优化程控是今后发展的方向。Cardiac resynchronization therapy（CRT）is an effective and new way for treating the patients with chronic heart failure. However,the clinical multicentre trial called CARE-HF showed that 20% -30% patients who underwent implantation of biventricular pacemakers did not response to the CRT. As we know, there are three ways to improve the curative effect. In spite of the choice of strict indication and optimized pacing site on CRT,to optimize the atrioventricular（ AV） and interventricular（ VV） delay is an effective way. Up to now,many methods of optimizing the AV/VV delay such as the ECG, echocardiology, the radionuclide ventriculography and the MRI have been posed. As for the ECG, it is simple and theoretical for optimizing the AV/VV delay. But the ECG neglect the mechan oelectrical delay of the myocardium tissue. Compared with ECG, echocardiology is an important and practical way to optimize the AV/VV delay. To tell the truth, we faced with great challenge for optimizing the AV/VV delay,because the best optimized AV delay is various in different people and is changed with the heart rate. So optimizing AV delay dynamically and personally is the future tendency.

关 键 词：心脏再同步治疗 AV间期 VV间期 组织多普勒 可控的心室腔内电图 

分 类 号：R541.6[医药卫生—心血管疾病]