双心室起搏兼顾房室结优先对QRS波影响的研究

The research of Maintaining atrioventricular intrinsic conduction during cardiac resynchronization therapy can get the further narrowing of the QRS complex

目的探索接受抗心衰起搏治疗的患者，通过双室起搏兼顾房室结优先，力求QRS波进一步变窄的可能性和方法。方法选取2008年5月至2012年12月昆明医科大学一附院心内科收住人院，确诊为慢性充血性心力衰竭、有CRT—P／D适应证并成功植入抗心衰三腔起搏器的患者60例，其中男性47例、女性13例，平均年龄（63．87±9．29）岁。术后随访期内，所有患者均分别给予双室起搏兼顾房室结优先和传统双室起搏两种CRT工作模式。比较兼顾模式和传统模式在心电图QRS波宽度上的差异。结果60例患者的CRT系统在静息状态下均可借助程控仪和12导体表心电图监测，实现传统和兼顾两种CRT工作模式（成功率100％），且两种CRT工作模式的QRS波平均宽度均分别小于CRT术前[（115．78±19．30）ms、（137．03±19．76）ms比（155．72±28．78）ms，P均〈0．01]。静息状态下，兼顾模式的QRS波平均宽畸程度低于传统模式，QRS波平均时限短于传统模式[（115．78±19．30）ms比（137．03±19．76）ms，P〈0．01]。兼顾模式的QRS波平均宽度较传统模式减少15．5％。结论传统CRT工作模式强调100％双室起搏夺获，弃用自身房室传导，造成QRS波偏宽畸，可能是部分患者对CRT无应答的原因之一。

Objective To explore the methodology of atrioventricular node priority and narrow QRS wave in patients of heart failure with double ventricular pacemaker therapy. Methods 60 cases of patients with heart failure admitted to Kunming medical university hospital in May 2008 to December 2012, and successfully implant- ed pacemaker of three Chambers were enrolled [ 47 cases male, female 13 cases, mean age （63.87±9.29）years ]. During postoperative follow-up period, all patients were given double chamber pacemaker atrioventricular node pri- ority or traditional dual chamber pacing. The QRS wave width of electrocardiogram was compared. Results Two kinds work models of CRT can be relized by program-controlled apparatus and 12 leads ECG monitoring in 60 pa- tients（ 100% ）. The average width of QRS wave in two kinds modes of the CRT were respectively less than preoper- ation [ （ 115.78±19.30）ms, （ 137.03±19.76）ms and （ 155.72±28.78）ms respectively, P〈0.01 ]. Resting state, the combining pattern of wide QRS wave average abnormal degree was lower than the traditional model, QRS wave of average time limit shorter than traditional mode [ （115.78±19.30）ms and （137.03_±19.76）ms, P〈0.01 ]. Both the average width than traditional mode of QRS wave model is reduced by 15.5%. Conclusion The traditional CRT work mode emphasizes, dual chamber pacing, took 100%, abandoned their atrioventricular conduction, wide QRSwave caused by partial abnormal, could be a part of patients to the CRT is one of the reasons for no answer.