右室感知触发左室起搏心脏再同步化治疗慢性充血性心力衰竭

摘要

目的 探讨右室感知触发左室起搏心脏再同步化治疗(CRT)慢性充血性心力衰竭(CHF)的效果.方法植入三腔起搏器进行心脏超声优化的CHF患者30例,分别测定传统CRT优化后及右室感知触发左室起搏CRT模式的左室射血分数(LVEF)、舒张期二尖瓣血流速度时间积分(MVI)、二尖瓣返流VTI(MR-VTI)、主动脉瓣前向血流VTI(AVI),并与CRT术前及传统CRT右室优先模式(11例)比较上述心脏超声指标、QRS波时限、优化耗时及CRT费用的差别.结果 右室感知触发左室起搏模式的平均电池寿命长于传统CRT模式,QRS波时限、优化耗时及CRT年平均费用少于传统CRT模式(均P＜0.01)；AVI、LVEF、MVI、MR-VTI与传统CRT模式无差异(均P＞0.05),但与传统CRT模式高度相关(P＜0.01).右室感知触发左室起搏模式的AVI、LVEF、MVI较右室优先模式增加,MR-VTI较右室优先模式减少(P均＜0.05).结论 右室感知触发左室起搏较右室优先的传统CRT模式改善CHF患者的血流动力学,降低CRT年平均费用.%Objective To investigate the effect of right ventricular (RV) sensing trigger left ventricular (LV) pacing in the therapy of chronic congestive heart failure. Methods Thirty patients with left bundle branch block who underwent cardiac echocardiographic optimization after biventricular (BVP) pacemaker implantation were enrolled, and LV ejection fraction ( LVEF), mitral velocity time integral (MVI) , mitral regurgitation velocity time integral (MR-VTI), aortic velocity time integral (AVI) ,QRS duration were recorded and compared during intrinsic conduction without pacing, optimized BVP, RV sensing trigger LV pacing and sequential BVP with RV preservation. Results The mean battery life of RV sensing trigger LV pacing was longer than sequential BVP (P <0.01). Time consuming of optimization, QRS duration and mean cost of CRT were less than those of sequential BVP ( all P < 0.01). There were no difference of AVI, LVEF, MVI and MR-VTI between RV sensing trigger LV pacing and sequential BVP, but closely related with those of sequential BVP (all P <0.01). AVI, LVEF, MVI were improved and MR-VTI was decreased in RV sensing trigger LV pacing than those of sequential BVP( all P < 0.05 ). Conclusion RV sensing trigger LV pacing improves hemodynamics than sequential BVP with RV preactivation, and reduces mean cost of CRT.