左心室四极导线在心脏再同步治疗中的初步疗效评价  

Clinical evaluation of quadripolar left ventricular leads in cardiac resynchronization therapy

作　　者：胡凯[1] 陈康玉[1] 严激[1] 徐健[1] 苏浩[1] 安春生[1] 宇霏[1] 王齐[1] 杨冬妹[1] 

机构地区：[1]安徽省立医院心血管内科,合肥230001

出　　处：《中华心律失常学杂志》2016年第2期95-99,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：2013年安徽省科技攻关计划项目（1301042210）;安徽省“115”产业创新团队项目

摘　　要：目的旨在评价左心室4极导线在慢性心力衰竭（心衰）患者心脏再同步治疗（CRT）中的疗效。方法纳入安徽省立医院心内科2013年9月至2015年6月113例CRT患者，根据左心室导线的类型，分为4极导线组（37例）和双极导线组（76例），随访6个月，超声心动图评价两组患者急性血流动力学、心脏结构及同步性指标，比较两组术后各项指标的差异。结果两组患者年龄、性别、服用药物、心功能等基线资料差异无统计学意义。两组患者在CRT术后每搏量（SV）、主动脉速度时间积分（VTI）、Qrts时限、左心室12节段的收缩速度达峰时间标准差（Ts-SD）均有明显改善，且4极导线组较双极导线组改善更加显著（P〈0．05）。3个月时4极导线组左心室射血分数（LVEF）较术前有明显改善，且改善程度高于双极导线组（0．33±0．11对0．30±0．07），但差异无统计学意义（P〉0．05）。随访至6个月，4极导线组左心室收缩末期容积[LVESV，（174．2±93．5）ml对（210．0±81．4）ml]、LVEF（0.39±0.13对0．34±0.09）、短轴缩短率（FS，19．8％±7．8％对16．5％±44％）均优于双极导线组（P〈0．05）。至术后6个月，4极导线组超反应发生率稍高于双极导线组，但差异无统计学意义（32．4％对26．3％，P=0．498），而无反应发生率虽然低于双极导线组（21．6％对34．2％），但差异无统计学意义（P=0．24）。结论与传统双极导线相比，左心室4极导线在获得更好的急性血流动力学和同步性的同时，可进一步逆转左心室重构。Objective To evaluate the efficacy of a quadripolar left ventricular（LV） lead in improving the response to cardiac resynchronization therapy（CRT）. Methods A total of 113 patients received CRT who had complete follow-up data in Anhui Provincial Hospital from September 2013 to June 2015 were selected and divided into quadripolar lead group （ 37 patients ） and bipolar lead group （ 76 patients ） according to the type of left ventricular lead.All patients were followed up for 6 months after implantation.CRT efficacy was assessed by echocardiography. Results There were no significant differences between the two groups at baseline.Stroke vol- ume（SV） ,aortic velocity time integral（VTI） ,QRS duration,standard deviation of 12 LV segments＇ Ts（Ts-SD） were significantly improved in both groups and were better in quadripolar lead group after implantation than in bipolar lead group（P〈0. 05）. After 3 months, the LVEF was no significant difference between the two groups （P〉0. 05） ,but the LVEF in quadripolar lead group was higher than that in bipolar lead group（0. 33±0. 11 vs. 0. 30±0.07）.There were significant differences in Left ventficular end-systolic volume [ LVESV, （ 174. 2±93.5） ml vs. （210. 0±81.4） ml） ,LVEF（0. 39±0. 13 vs.0. 34±0. 09）, FS （ 19. 8% ±7.8% vs. 16. 5%±4.4%） after 6 months（P〈0.05） .Quadripolar lead group had a higher surper-response rate（ 32.4% vs.26. 3% ,P= 0. 498）and a lower non-response rate than bipolar lead group in tendency （21.6% vs.34. 2%, P = 0. 24）, but there were no significantce. Conclusions Compared with traditional bipolar lead, quadripolar LV lead could not only make better contributions to acute hemodynamic response and heart synchronicity, but also increase the degree of left ventricular reverse remodeling to CRT.

关 键 词：心脏再同步治疗 4极导线 

分 类 号：R541.6[医药卫生—心血管疾病]