左室起搏电极部位对心脏再同步化治疗疗效的影响

Impact of left ventricular lead position on clinical outcome of cardiac resynchronization therapy.

目的探讨左室起搏电极部位对心脏再同步化治疗(CRT)效果的影响。方法 121例慢性心功能不全患者接受CRT,其中93例将左室电极植入侧后静脉、侧静脉或后静脉(A组),另16例植入心中静脉(B组)、12例植入心大静脉(C组);所有患者术前及术后6个月行纽约心功能(NYHA)分级,常规心电图及超声心动图检查。结果 A组患者术后NYHA分级得到显著改善,QRS波时限变窄,左室射血分数显著提高,左室舒张末内径、左室收缩末内径显著缩小(P<0.01);B组患者超声心动图部分指标及QRS波时限显著改善,但其NYHA分级无显著改变;而C组患者术后各项指标均无显著改善(P>0.05)。结论 CRT时应尽可能将左室电极置于左室侧壁或侧后壁。

Objective To discuss the impact of left ventricular （LV） lead postion on clinical outcome of cardiac resyn- chronization therapy （CRT）. Method A total of 121 patients with chronic heart failure received CRT, among whom 93 cases had a LV lead placed in posterolateral vein, lateral vein or posterior vein （group A） ; 16 cases placed in middle car- diac vein （group B） and 12 cases in great cardiac vein （group C）. Before and 6 months after implantation, NYHA func- tional class, electrocardiogram and eehocardiography were evaluated for all the subjects. Results As for subjects in group A, NYHA class improved, QRS duration narrowed, LV ejection fraction elevated and LV dimension （both end-dias- tolic and end-systolic） reduced after CRT（ P 〈0.01 ） ; though part of echocardiographic parameters and QRS duration were significantly improved in group B, their NYHA class had no significant change ; In group C, none of these parameters were improved （ P 〉 0.05 ）. Conclusion The LV lead ought to be placed at the lateral or posterolateral wall of left ventricle in CRT.