CAJ | 학술논문

目的探讨心脏再同步治疗(CRT)术中测定腔内心电图参数,尤其是左心室激动延迟时间是否可以预测心力衰竭患者左心室逆重构发生.方法 2009年1月至2013年1月37例完全性左束支阻滞患者在天津市胸科医院心内科植入CRT,术中测试窦性心律自身传导情况下右心室-左心室导线的激动时间差(△t),测试右心室导线起搏到左心室导线感知时间(RVp-LV)及左心室导线起搏到右心室导线感知时间(LVp-RV).随访观察1年,比较术前、术后心脏结构变化,以左心室舒张末期容积减小15％或射血分数提高5％为标准分为CRT应答组和无应答组.结果左心室逆重构的发生与术中测试腔内心电图△t、RVp-LV、LVp-RV等参数均无明显关系,△t与术前QRS时限有关,RVp-LV、LVp-RV在左心室舒张末期内径(LVEDD) ＞75 mm的患者中长于LVEDD≤75 mm的患者(P＜0.05).左心室导线植入在左心室基底部、中段、心尖部的患者发生左心室逆重构的比例分别为71.4％、90.4％、12.5％,差异有统计学意义(P＜0.05),3个部位的△t、RVp-LV、LVp-RV差异无统计学意义.结论术中测定腔内心电图相关参数不能预测CRT是否应答,左心室导线位置仍是决定CRT疗效的关键因素.
목적 탐토심장재동보치료(CRT)술중측정강내심전도삼수,우기시좌심실격동연지시간시부가이예측심력쇠갈환자좌심실역중구발생.방법 2009년1월지2013년1월37례완전성좌속지조체환자재천진시흉과의원심내과식입CRT,술중측시두성심률자신전도정황하우심실-좌심실도선적격동시간차(△t),측시우심실도선기박도좌심실도선감지시간(RVp-LV)급좌심실도선기박도우심실도선감지시간(LVp-RV).수방관찰1년,비교술전、술후심장결구변화,이좌심실서장말기용적감소15％혹사혈분수제고5％위표준분위CRT응답조화무응답조.결과 좌심실역중구적발생여술중측시강내심전도△t、RVp-LV、LVp-RV등삼수균무명현관계,△t여술전QRS시한유관,RVp-LV、LVp-RV재좌심실서장말기내경(LVEDD) ＞75 mm적환자중장우LVEDD≤75 mm적환자(P＜0.05).좌심실도선식입재좌심실기저부、중단、심첨부적환자발생좌심실역중구적비례분별위71.4％、90.4％、12.5％,차이유통계학의의(P＜0.05),3개부위적△t、RVp-LV、LVp-RV차이무통계학의의.결론 술중측정강내심전도상관삼수불능예측CRT시부응답,좌심실도선위치잉시결정CRT료효적관건인소.
Objective To evaluate the significance of intracardiac electrogram in predicting ventricular remodeling after cardiac resynchronization therapy(CRT).Methods Thirty-seven subjects with standard indications for CRT underwent intracardiac electrogram measurements and echocardiogram.All the left ventricular (LV) leads were placed in lateral vein.After 12 months follow-up,echocardiogram was done again.A reduction of LV end-systolic volume ≥ 15％ or improvement of LV ejection fraction ≥ 5％ was used to define CRT responders.Results The interval between the onset of right ventricle (RV) lead and LV lead electrograms (△t),the interval between RV pacing and LV sensing (RVp-LV),the interval between LV pacing and RV sensing(LVp-RV) had no statistic difference between responders and non-responders and had no difference between different LV leads location.The patients with middle segment location of LV leads had higher reverse LV remodeling than patients with apical positioned LV Leads (90.4％ vs.12.5％,P＜0.05).Conclusions It was LV leads location predict LV reverse remodeling but not intracardiac electrogram at 12 months after CRT.