心室再同步化起搏的心电图表现及随访

Electrocardiographic pattern and follow up in biventricular resynchronization pacing.

目的探讨不同心室起搏部位体表十二导联心电图的变化及在双心室再同步起搏(CRT)随访中的应用。方法22例资料完整的充血性心力衰竭患者进行双心室再同步起搏治疗,其中21例经静脉置入左室导线,1例因冠状静脉窦畸形经胸左室外膜导线置入;右室导线均放置在心尖部。22例分别记录无起搏、右室起搏、左室起搏及双心室同步起搏四种不同状态下的十二导联心电图。结果22例术前心电图显示完全性左束支传导阻滞(CLBBB)16例,完全性心室内传导阻滞6例,行右室心尖部起搏时胸前导联(V1)均呈CLBBB型,肢体导联额面电轴左偏,Ⅰ导联呈r、R型占100%,左室起搏时胸前导联(V1)均呈右束支传导阻滞(CRBBB)型,额面电轴右偏,Ⅰ导联呈q、Q、QS型20例,占91%;双心室同步起搏后胸前导联(V1)呈CLBBB型13例,呈CRBBB型9例,额面电轴均右偏,Ⅰ导联呈q、Q、QS型占86.5%。结论不同部位心室起搏具有不同的心电图表现,双心室同步起搏具有特征性的心电图形态,CRT随访时通过对心电图形态和时限的观察有助于判断是否实现真正有效的双心室再同步起搏。

Objective To observe the variable pattern in multisite pacing for the treatment of heart failure,twelve-lead ECG was used as the index of evaluation in biventricular pacing. Methods 22 patients with congestive heart failure （CHF） were undergone cardiac resynchronization therapy. 21 transvenous left ventricular lead placements were finished, one epicaridal left ventricular lead was fixed in a patient for coronary sinus abnormality; 22 right ventricular leads were implanted in right ventricular apex. All patients were recorded twelve-lead ECG during non pacing, right ventricular pacing, left ventricular pacing and biventricular pacing, respectively. Results Electrocardiogram in 16 patients represented as completed left bundle branch block （CLBBB） pattern before operation. 6 patients represented intra-ventricular conduct block. During right ventricular apex pacing, the paced QRS in chest lead showed CLBBB pattern with frontal plane axis left deviation. The pattern of r and R in lead Ⅰ was displayed in all patients. During left ventricular pacing, the paced QRS all represented completed right bundle branch block（CRBBB） with frontal plane right axis deviation and the pattern of q, Q and QS showed in 20 patients （account for 91% in all patients）. During biventricular pacing , the pattern of chest ECG displayed CLBBB in 13 patients and CRBBB in 9 patients with frontal plane axis right deviation. And the pattern of q, Q and QS was showed in 86.5% patients. Conclusion Different pacing site has different ECG appearance. As well as, biventricular pacing has special ECG pattern. Such pattern is helpful for following up post CRT in patients with CHF. Furthermore, we can estimate the presence of biventricular capture.