心脏再同步治疗术中不同起搏模式对室性心律失常诱发的影响  

Effects of biventricular pacing with different timing offsets on the induction of ventricular arrhythmias

作　　者：丁立刚[1] 华伟[1] 王欢[1] 乔青[1] 王靖[1] 刘志敏[1] 樊晓寒[1] 陈柯萍[1] 张澍[1] 

机构地区：[1]中国医学科学院心血管病研究所北京协和医学院阜外心血管病医院心律失常中心,100037

出　　处：《中华心律失常学杂志》2012年第3期184-187,共4页Chinese Journal of Cardiac Arrhythmias

基　　金：高校博士点基金（200800230010）,中国医药卫生事业发展基金会

摘　　要：目的评价心脏再同步治疗（CRT）植入术中不同起搏模式对室性心律失常诱发情况的影响。方法连续人选植入心脏再同步治疗除颤器（CRT—D）的患者，术中采用3种起搏模式：右心室起搏、双心室同步起搏和双心室顺序起搏（左心室优先50ms和80ms，右心室优先50ms和80ms）。然后分别从左心室或右心室导线引入最多2个期前刺激，评估室性心律失常的诱发情况。结果共有15例成功植入CRT—D的患者人选，男11例，年龄49—72（61±7）岁。缺血性心肌病7例，扩张型心肌病8例。左心审射血分数0．30±0．07。9例患者发生终点事件：5例诱发持续性室性心动过速（VT）／心室颤动（VF），4例诱发非持续性VT。双心室同步起搏时未诱发持续性VT／VF事件，双心室顺序起搏时有5例诱发VT／VF（P〈0．01）。结论双心室顺序起搏模式可能具有潜在致心律失常作用。双心室顺序起搏模式下心脏电生理刺激或自发的室性期前收缩对衰竭心脏电生理稳定性的影响需长期临床研究进一步证实。Objective To examine the effect of cardiac resynchronization therapy defibrillator（CRT- D） with left vcntricular-right ventrieular （LV-RV） timing offsets on inducibility of ventricular arrhythmias. Methods We conducted clectrophysiology study in 15 patients who underwent CRT-D implant under three pa- cing conditions ： RV pacing, LV-RV simultaneous pacing and CRT with LV-RV timing offsets at 0 ms, ±50 ms, ±80 ms,-50 ms,and -80 ms （± means LV ahead of RV and -means RV ahead of LV）. Up to two extra-stim- uli were introduced through RV or LV lead. Results The mean ages were（61 ± 7）years and mean left ven- tricular ejection fraction （LVEF） was 0. 30 ± 0. 07. Seven patients had ischemic cardiomyopathy and eight had t;onischemic cardiomyopathy. Nine patients （60%） had either sustained ventricu]ar tachycardia/ventrieular iibrillation（VT/VF） （5 patients） or more than 10 beats of non-sustained VT （4 patients）. The difference in patients with imtuciblc VT/VF between CRT-D with and without LV-RV timing offset was statistically signifi- cant （ P〈 0. 01 ）. Conclusions CRT-D with LV-RV timing offset may potentiate the inducibility of ventricular arrhythmias in patients with advanced heart failure. Long-term studies are needed to correlate the findings from the programmed electrical stimulation and the spontaneous ventricular arrhythmias and to examine the potential detrimental effect of LV-RV timing offsets on electric stability of the heart.

关 键 词：心脏再同步治疗 电生理刺激 室性心律失常 起搏 

分 类 号：R541.7[医药卫生—心血管疾病]