腔内心电图指导心脏再同步化治疗术后手动优化新算法的研究

A Study on Evaluate the New Manual Algorithm Guided by Intracardiac Electrogram for Optimization of Cardiac Resynchronization Therapy

目的:提出新的腔内心电图(IEGM)指导心脏再同步化治疗(CRT)手动优化算法(手动法),并验证其合理性。方法:通过前瞻性自身对照研究比较手动和传统的自动及超声优化的参数及急性血流动力改变,包括房室间期(AV)、室间间期(VV)、主动脉血流速度时间积分(AVTI)。分析三种方法参数的相关性,并以重复测量的方差分析进行多重比较。结果:37例患者均分别采用手动法、自动法及超声法,测每种方法优化后的主动脉血流速度时间积分(AVTI)并统计耗时。结果手动法AV(156.76±52.28)cm,VV(16.76±22.24)cm,AVTI(20.33±3.55)cm;自动法AV(152.97±53.12)cm,VV(24.05±22.91)cm,AVTI(18.57±3.34)cm;超声法AV(167.57±46.51)cm,VV(18.92±23.78)cm,AVTI(24.79±4.15)cm。相关分析示三种方法参数间呈正相关,P<0.05;重复测量的方差分析及多重比较显示:手动法与超声法VV间期差异无统计学意义,P=0.499,其它三种方法两两之间参数差异均有统计学意义,P<0.05。手动法耗时(5.23±1.88)min、自动法耗时(1.98±0.50)min均较超声法耗时(196.44±16.55)min明显减少,P<0.05。结论:新的手动法用于CRT优化具有合理性及临床推广价值。

Objective：To propose a new manual algorithm guided by intracardiac electrogram（IEGM） for the optimization of cardiac resynchronization therapy （CRT） by the evaluation of the rationality of the method.Methods：New algorithm method was compared with traditional automotive method and echocardiographic method by a prospective self-contrasting study to access the parameter settings and the acute hemodynamic effects of each optimization method,including Atrioventricular interval （AV）,interventricular interval （VV） interval,and aortic time velocity integrals （AVTI）.Correlations between parameter settings of each method were calculated and the multiple comparisons were accessed by analyses of variance of repeated measures.Results：37 patients were involved in this study,and every case of CRT optimization accepted manual method,automotive method and echocardiographic method respectively,meanwhile,the artic time velocity integrals （AVTI） and operating time were measured.Descriptive statistics of parameter settings of each method were as follows：manual method,AV （156.76±52.28）cm,VV（16.76±22.24）cm ,AVTI（20.33±3.55）cm;automotive method,AV （152.97±53.12）cm,VV（24.05±22.91）cm ,AVTI（18.57±3.34）cm;echocardiographic method,AV （167.57±46.51）cm,VV（18.92±23.78） cm,AVTI（24.79±4.15）cm.Positive correlations of parameter settings between each method were revealed by Pearson correlation coefficients,P〈0.05,while the analyses of variance of repeated measures and multiple comparisons showed statistics significances of the differences of paired comparison between each method,P〈0.05,excepting the comparison between VV settings of manual method and echocardiographic method,P=0.499.The operating time was obviously reduced by using the manual method（5.23±1.88）min and automotive method（1.98±0.50）min,compared with echocardiographic method （196.44±16.55）min ,P〈0.05.Conclusion：The new manual method provides a quick and reasonable clinic alternative to the generalization of CRT optimization.