左心室电激动延迟程度及左、右心室起搏位点距离优化左心室起搏位点选择  

Application and efficacy of the adjustment on left ventricular electrical delay and the distance between right and left ventricular pacing polar in optimizing the left ventricular pacing polar

作　　者：焉晓蕾 梁延春 于海波 徐白鸽 高阳 刘荣 许国卿 武敏 Yan Xiaolei;Liang Yanchun;Yu Haibo;Xu Baige;Gao Yang;Liu Rong;Xu Guoqing;Wu Min(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院心血管内科,沈阳110016

出　　处：《中华心血管病杂志》2020年第8期669-674,共6页Chinese Journal of Cardiology

基　　金：国家重点研发计划(2016YFC0900904,2016YFC0900905)。

摘　　要：目的探讨左心室电激动延迟程度(LVED)及右心室与左心室起搏位点的距离(DRLV)在优化左心室起搏位点中的应用及疗效。方法选取2014年1月至2018年1月在北部战区总医院接受应用左心室四极电极进行心脏再同步治疗(CRT)的心力衰竭患者,测量其左心室4个起搏位点的LVED及DRLV。按如下流程优化选择左心室起搏位点:(1)避免膈神经刺激(PNS);(2)合适的起搏阈值;(3)避开心尖部起搏;(4)选择最大LVED;(5)选择最大DRLV。按流程选择左心室起搏位点进行CRT,统计左心室四极电极置入的靶血管分布情况。记录术后6个月随访时患者的双心室起搏百分比;比较患者术前及术后6个月的QRS波时限、左心室收缩末容积、左心室射血分数、左心室舒张末内径、6 min步行距离、纽约心脏病协会(NYHA)心功能分级,并统计CRT术后有应答及超声心动图检查有应答的患者比例。结果入选29例心力衰竭患者,男性19例(66%),年龄(61.7±7.6)岁。扩张型心肌病17例(59%),缺血性心脏病12例(41%)。所有患者均成功置入左心室四极电极至靶血管内,且4个起搏位点亦均在靶血管内,侧静脉15例(52%),前静脉2例(7%),后静脉11例(38%),心大静脉侧分支1例(3%)。术后6个月双心室起搏百分比均大于95%。以最大的LVED及最大的DRLV作为依据选择左心室起搏位点的患者分别有19例(66%)和4例(14%)。最终29例患者中,有5例(17%)以D1作为起搏位点,5例(17%)以M2作为起搏位点,7例(24%)以M3作为起搏位点,12例(41%)以P4作为起搏位点。10例(34%)患者应用了传统双极电极具备的起搏位点(D1、M2),19例(66%)患者应用了左心室四极电极特异的起搏位点(M3、P4)。29例患者术前QRS波时限、左心室收缩末容积、左心室射血分数、左心室舒张末内径、6 min步行距离、NYHA分级分别为(171±24)ms、(231±79)ml、(28±5)%、(74±11)mm、(294±103)m、(3.2±1.0)级;术后6个月分别为(130±12)ms、(158±73)ml�Objective To investigate the application and efficacy of left ventricular(LV)electrical delay(LVED)and the distance of right ventricular(RV)pacing polar to LV(DRLV)in optimizing LV pacing polar.Methods Heart failure(HF)patients who implanted cardiac resynchronization therapy(CRT)device with a LV quadripolar lead from January 2014 to January 2018 at General Hospital of Northern Theater Command were enrolled in the study.Measurements of LVED and DRLV of each polar of the lead were performed in patients with HF who underwent CRT with LV quadripolar lead.The principle in turn for polar selecting used for clinical LV pacing was the pacing polar:(1)without phrenic nerve stimulation(PNS);(2)with appropriate capture threshold;(3)not located in apical;(4)with maximal LVED;(5)with maximal DRLV.The LV pacing polar was selected for CRT according to the procedure.The distribution of target veins implanted with LV quadripolar lead were calculated.The percentage of biventricular pacing at 6-month follow-up was recorded.The following indexes were compared before and 6-month after surgery,including QRS duration,LV end-systolic volume(LVESV),LV ejection fraction(LVEF),LV end-diastolic dimension(LVEDD),6 minute walking distance(6MWD),New York Heart Association(NYHA)class.The efficacy and echocardiographic efficacy of CRT was evaluated.Results There were twenty-nine HF patients enrolled.The mean age of enrolled patients was(61.7±7.6)years old,nineteen(66%)of them were male.There were seventeen(59%)patients diagnosed as dilated cardiomyopathy and twelve(41%)patients as ischemic cardiomyopathy.All patients were successfully implanted with LV quadripolar lead into target veins,and all four pacing sites were also in target veins.Target veins were located in lateral veins in 15 patients(52%),anterior veins in 2 patients(7%),posterior veins in 11 patients(38%),and lateral branches of great cardiac veins in 1 patient(3%).After 6-month of follow-up,the percentage of biventricular pacing was greater than 95%.There were nineteen(66%)patients

关 键 词：心脏再同步治疗 左心室 电极 心脏起搏 

分 类 号：R541.6[医药卫生—心血管疾病]