心室感知反应的心脏再同步化治疗对慢性心力衰竭伴持续性心房颤动的疗效

The effects of cardiac resynchronization therapy with ventricular sensing response in patients with congestive heart failure and coexistent atrial fibrillation

心脏再同步化治疗（CRT）已经成为慢性心力衰竭（CHF）合并室内传导障碍患者的治疗方法之一。然而,国外文献报道CRT无应答的发生率在20%～30%。无应答的原因很多,其中之一就是相当一部分CHF患者伴发心房颤动（AF）导致双心室起搏的比例显著降低。本研究应用美国Medtronic公司的CRT或CRT-D心室感知反应（ventricular sensing response,VSR）新功能，比较AF患者开启VSR功能前后QRS波时限、双心室起搏比例、临床参数及超声心动图参数的变化，进而评价VSR功能的临床疗效。

To evaluate biventricular（BiV）pacing percentage and clinical outcomes of cardiac resynchronization therapy with ventricular sensing response（VSR）in patients with congestive heart failure（CHF）and coexistent atrial fibrillation（AF）.A total of 35 patients were on an optimal medical heart failure regime and CRT therapy.We actived VSR and followed up for six months in 22 patients with CHF and coexistent AF after CRT device implantation 6month.We compared the changes of VSR percentage,QRS width,BiV pacing percentage,clinical parameter（NYHA class,6-min walk test）and echocardiographic parameter（LVEF and LVEDD）between active and inactive VSR.We also compared the changes of above parameters between sinus rhythm group and AF group.After active VSR,above parameters were significantly improved（P〈0.05）.Above parameters were significantly difference（P〈0.05）between sinus rhythm group and AF group.CRT therapy with VSR improved BiV pacing percentage as well as clinical outcomes in patients with CHF and coexistent AF.