双心室起搏室间间期优化新算法的研究

Evaluation of the Optimized Algorithm for Interventricular Intervals in Biventricular Pacing Therapy

目的提出双心室起搏室间间期(VV)优化新算法,并验证其合理性。方法选择2009年6月-2012年12月间在成都市第三人民医院心内科住院的慢性心力衰竭并接受双心室起搏是心脏再同步化治疗的患者41例,根据心脏电-机械耦联的原理,将体表心电图和超声指标的数量关系用新公式来表述,通过前瞻性自身对照研究来比较新算法与传统方法的差异。结果 41例患者均分别采用新算法、传统超声法及腔内心电图法进行VV优化,测主动脉血流速度时间积分(AVTI)并统计耗时。经方差分析显示新算法的AVTI[(22.32±3.48)cm]优于传统腔内心电图法的AVTI[(19.22±3.07)cm],组间差异有统计学意义(P<0.05);而新算法的耗时[(18.80±3.30)min]较传统超声法的耗时[(203.81±20.12)min]明显减少,组间差异有统计学意义(P<0.01)。结论新算法用于双心室起搏是心脏再同步化治疗的VV优化准确、快速,具有合理性及临床推广价值。

Objective Topropose a new optimized algorithm for interventricular intervals （VV） and give assessment for the algorithm. Methods Forty-one patients with chronic heart failure treated with biventricular pacing and cardiac resynchronization in the Third People＇s Hospital of Chengdu between June 2009 and December 2012 were included in our study. The quantitative relationship between electrocardiographic and echocardiographic parameters was presented by a new formula on the basis of the principle of cardiac electrical mechanical coupling. Every case of VV optimization accepted new algorithm method, traditional echocardiographic method, and traditional intracardiac electrogram （IEGM） method respectively. Prospective self-control study was performed to compare the new algorithm and traditional methods. Results New algorithm method showed higher AVTI values （22.32 ~ 3.48） cm compared with traditional IEGM method （19.22 ± 3.07） cm （P 〈 0.05） and the operating time was reduced by using the new algorithm method （18.80 ± 3.30） min compared with traditional echocardiographic method （203.81 ± 20.12） min （P 〈 0.01）. Condusion The new algorithm provides a more reliable and simpler clinic alternative to the generalization of CRT optimization.