双心室起搏模式下心力衰竭患者的心脏电-机械耦联研究  

Cardiac Electromechanical Coupling in Patients with Heart Failure Under Biventricular Pacing Mode

作　　者：汪汉 蔡琳 邓晓奇 李锦 童琳 刘汉雄 WANG Han;CAI Lin;DENG Xiaoqi;LI Jin;TONG Lin;LIU Hanxiong(Department of Cardiology,The Affiliated Hospital of Southwest Jiaotong University,The Third People’s Hospital of Chengdu,Cardiovascular Disease Research Institute of Chengdu,Chengdu 610031,Sichuan,China)

机构地区：[1]西南交通大学附属医院,成都市第三人民医院心内科,成都市心血管病研究所,四川成都610031

出　　处：《心血管病学进展》2022年第4期380-384,共5页Advances in Cardiovascular Diseases

基　　金：中国健康与医疗发展基金会(NCT00918294-2008-zhFj1);成都市“十一五”科技攻关重大专项(07YTYB957SF-020)。

摘　　要：目的探讨双心室起搏模式下心力衰竭患者心脏电-机械耦联的数量关系,设置理想VV间期。方法选择2007年6月—2009年4月准备行心内电生理检查的心力衰竭患者20例,标测电极导管于左心室后游离壁、右心室心尖、左心室前间隔及右心室前间隔4个部位,通过Ensite Array非接触式标测球囊多电极导管记录电同步性,以彩色多普勒超声诊断仪的向量速度显像记录机械同步性,分析电活动及机械运动的耦联关系。结果ΔT_(电机械)在空间分布上具有不均匀性,且与心室解剖部位密切相关(P<0.001),双心室起搏引起的机械收缩同时到达中心部位的VV间期可表述为0.5(LVPace~P-RVPace~A)。结论心力衰竭患者心脏电与机械活动存在不同步性,利用电-机械耦联原理可设计较为理想的VV间期。Objective To explore the quantitative relationship on cardiac electromechanical coupling of heart failure patients in biventricular pacing mode and provide a new algorithm on setting an ideal VV interval.Methods A total of 20 patients with heart failure underwent electrophysiological examination from June 2007 to April 2009 were enrolled.The electrode catheter was placed in left ventricular posterior free wall,right ventricular apex,left and right ventricular anterior septum.The electronical synchronization was recorded by Ensite Array non-contacting mapping-balloon multielectrode catheter and the mechanical synchronization recorded by vector velocity imaging of Doppler echocardiography.The coupling relationship between electrical activity and mechanical motion was analyzed.Results The differences between the start time of electrical activation and the time of mechanical movement showed an uneven spatial distribution and were closely related to ventricular anatomical sites(P<0.001).The VV interval of mechanical contraction simultaneously reaching the center caused by biventricular pacing could be expressed as“0.5(LVPace~P-RVPace~A)”.Conclusion There exists an asynchrony between cardiac electrical and mechanical activity in patients with heart failure.An ideal VV interval could be set on the principle of electromechanical coupling.

关 键 词：双心室起搏 心力衰竭 心脏电-机械耦联 心脏再同步化治疗 

分 类 号：R541.6[医药卫生—心血管疾病]