心电图与超声心动图优化VV间期的对比研究  

Comparative study of interventricular delay optimization in cardiac resynchronization therapy using electrocardiography versus using echocardiography

作　　者：安春生[1] 杨冬妹[1] 陈康玉[1] 徐健[1] 范西真[1] 孙贤林[1] 刘伏元[1] 苏浩[1] 黄向阳[1] 严激[1] 

机构地区：[1]安徽医科大学附属省立医院心内科,合肥230001

出　　处：《中华心律失常学杂志》2011年第5期350-353,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的 评价心电图在心脏再同步治疗（CRT）患者VV间期优化中的作用.方法 入选30例心功能Ⅲ～Ⅳ级（NYHA分级）CRT患者（男27例,女3例）,年龄42 ～79（63.3±10.6）岁.植入1个月后,分别程控为单独右心室起搏和单独左心室起搏,记录体表心电图.左心室起搏时,记录胸前导联从起搏信号到QRS波起始部假δ波结束之间的间期（T1）；右心室起搏时,记录胸前导联从起搏信号到QRS波开始改变之间的间期（T2）.T1 -T2的值为从心室侧壁与间隔部同步除极左心室所需的时间延迟,为最佳左-右心室激动的间期（Optimal VV间期）.同时采用超声扫描测定不同VV间期时的主动脉速度时间积分（VTI）,产生最大VTI间期为最佳VV间期,对比两种方法结果.结果 超声优化最佳VV间期在左心室领先起搏-30 ms、-70 ms时分别有20例、5例；左、右心室同步起搏（0 ～5 ms）时有3例；右心室领先起搏＋30 ms时有2例.心电图优化最佳VV间期在左心室领先起搏-30 ms、-70 ms时分别有19例和5例；左、右心室同步起搏时有4例；右心室领先起搏＋30 ms时有2例.两种方法相关性良好.结论 采用心电图可计算出CRT患者最佳VV间期,与超声心动图相关性良好.Objective To assess ECG-optimized-interventricular delay interval （VV）in cardiac resynchronization therapy.Methods Thirty cardiac resynchronization therapy（ CRT） patients with dilated cardiomyopathy and ischemic cardiomyopathy,NYHA class Ⅲ～ Ⅳ,were studied,mean age 42-79（63.3±10.6）.After one month follow-up,the patients were programmed to only LV（ left ventricule）pacing and only RV（ right ventricule） pacing,respectively.VV interval optimization was performed by ECG as follows：calculating the time from pacing spike to beginning of earliest deflection of QRS complex in precordial leads,first activating epicardial LV lateral wall（named as T1 ）and secondly during RV pacing（ named as T2）.The difference between T1 and T2 was regarded as a surrogate measurement of interventricular delay and defined as the optimal W interval.Echocardiography was performed to measure the optimal VV interval using maximal aortic VTI.Results By echocardiography,there were 20 patients and 5 patients who showed the optimal LV synchrony with LV preactivation at 30 ms,and 70 ms respectively,while 3 patients gained the most benefit from simultaneous pacing at 0 ～5 ms,2 patient achieved the maximum benefit with RV preactivation at 30 ms.With ECG,19 patients and 5 patients benefited the most with LV preactivation at 30 ms,and 70 ms,respectively.4 patients got the best benefit with simultaneous pacing at 0-5 ms,and 2 patients benefited most with RV preactivation at 30ms.Good concordance was found between the ECG-optimized and echocardiography-optimized VV interval（ K =0.937）.Conclusion For CRT patients,the optimal VV interval can be achieved by ECG which shows a good correlation with echocardiography.

关 键 词：心脏再同步治疗 心电图 超声心动图 

分 类 号：R541.7[医药卫生—心血管疾病]