强化随访结合心电图优化VV间期管理心脏再同步治疗无应答

Management of nonresponder to cardiac resynchronization therapy with disciplinary follow up and electrocardiogram VV interphase optimization

目的:探讨强化随访结合心电图优化VV间期对心脏再同步治疗(CRT)无应答病人的影响。方法:以2006年1月1日至2011年6月30日在我院植入CRT病人为研究对象,至2012年1月1日CRT应答者为A组,无应答者为B组,存活无应答者为C组,强化随访联合心电图VV间期优化半年后为D组。观察指标为死亡、NYHA心功能分级、6 min步行试验及左室射血分数(EF)。结果:共91例病人入选,经过中位34(6～62)个月随访,41例(占45.1%)对CRT无应答,A组与B组相比,缺血型心肌病及QRS宽度≤120 ms差异有统计学意义(均P<0.001)。经过强化随访半年后25例(占27.5%)对CRT无应答。C组与D组相比,NYHA心功能分级、6 min步行试验、EF、QRS宽度≤120 ms差异有统计学意义(均P<0.01)。常规随访后无应答率(占45.1%)与强化随访后无应答率(占27.5%)相比差异有统计学意义(P<0.01)。结论:缺血型心肌病及QRS宽度≤120 ms可能是无应答主要因素;强化随访结合心电图VV间期优化能改善临床症状以及提高EF。

Objective： To explore the influence of disciplinary follow-up with electrocardiogram optimization VV interphase to nonresponder to cardiac resynchronization therapy. Methods： Patients implanted CRT from January 1, 2006 to June 30, 2011 were selected as the research object. Till January 1 2012, responder was divided as group A, nonresponder as group B, survived group B as group C, after 6 months disciplinary follow-up as group D. To observe death, New York heart function classification, 6 minutes walk distance, EF. Results： A total of 91 patients were included, after the 34（6.0 - 62.0） months median of follow-up, 41 cases （45.1%） were nonresponders, A group compared with B group, ischemic cardiomyopathy and QRS width 〈 120 ms had statis- tic significance （P〈0.001）. After 6 months of disciplinary follow-up, 25 cases （27.5%） were nonresponders. New York Heart function classification, six minutes walk distance increased and EF increased （P〈0.01）. No response rate of regular follow-up and disciplinary follow-up were 45.1% and 27.5% respectively （P〈0.01）. Conclusion： Ischemic cardiomyopathy and QRS width 〈 120 ms may be nonresponders main factors. After the disciplinary follow-up combined with ECG VV interphase optimization, the clinical symptoms and the EF improve.