左心室四极导线对心脏再同步治疗除颤器患者术后室性心律失常的影响

Impact on the incidence of postoperative ventricular arrhythmias after cardiac resynchronizationtherapy defibrillator with quadripolar lead

目的本研究旨在评价左心室四极导线对心脏再同步治疗除颤器（CRT－D）患者术后室性心律失常的影响。方法入选安徽省立医院心内科自2013年6月至2016年6月间的CRT－D患者，根据左心室导线类型，分为四极导线组和双极导线组，比较两组术后随访过程中室性心律失常（VA）发生、抗心动过速起搏（ATP）、除颤治疗等各项指标的差异。以心衰再入院或心源性死亡为次要终点事件，评估两组预后。结果纳入研究的220例患者中，植入四极导线的患者58例，双极导线162例，两组患者的基线资料差异无统计学意义。随访显示，四极导线组与双极导线组VA平均发生次数差异无统计学意义[（0.60±2.38）次/人比（0.93±2.24）次/人，P＝0.055]；与双极导线组比较，四极导线组显著减少VA负荷[（0.22±0.91）次/人年比（0.46±1.13）次/人年，P＝0.044]，降低了除颤平均发生次数[（0.12±0.36）次/人比（0.23±0.52）次/人，P＝0.034]和除颤负荷[（0.04±0.17）次/人年比（0.12±0.46）次/人年，P＝0.029]，两组在ATP平均发生次数[（1.07±3.77）次/人比（1.26±3.01）次/人，P＝0.073]及其负荷[（0.38±1.39）次/人年比（0.63±1.48）次/人年，P＝0.058]比较差异无统计学意义。双极导线组和四极导线组术后生存情况差异无统计学意义（χ2＝0.463, P＝0.496）。结论与左心室双极导线相比，四极导线可显著减少CRT－D患者的VA负荷。

ObjectiveTo evaluate incidence of postoperative ventricular arrhythmias in patients who received cardiac resynchronization therapy defibrillator （CRT-D ） with left ventricular quadripolar lead.MethodsThe patients received CRT-D who had complete follow-up data in Anhui Provincial Hospital from June 2013 to June 2016 were included and divided into quadripolar lead group and bipolar lead group according to the type of left ventricular lead. And ventricular arrhythmia （VA）, implantable cardioverter-defibrillator （ICD） shocks treatment, antitachycardia pacing therapy （ATP）, and other indicators of the two groups were compared. Prognosis of the two groups was assessed by re-hospitalization for heart failure and cardiac death.ResultsOf the 220 patients enrolled in the study, 58 patients were in quadripolar lead group and 162 in bipolar lead group, and there were no significant differences in baseline characteristics between the two groups. The VA episode per patient was not significantly different between the two groups [（0.60±2.38） VA per person vs （0.93±2.24） VA per person, P=0.055]; the quadripolar lead group had significantly lower burden of VA compared with bipolar lead group [（0.22±0.91） per person-year vs （0.46±1.13） per person-year, P=0.044]. Compared with bipolar lead group, there were significant reduction in both the ICD shocks per patient and the burden of ICD shocks in quadripolar lead group： [（0.12±0.36） shocks per person vs （0.23±0.52） shocks per person, P=0.034] and [（0.04±0.17） per person-year vs （0.12±0.46） per person-year, P=0.029], respectively. There were no significant differences between the two groups in both the ATP per patient and the burden of ATP： [（1.07±3.77） ATP per person vs （1.26±3.01） ATP per person, P=0.073] and [（0.38±1.39） per person-year vs （0.63±1.48） per person-year, P=0.058], respectively. And there were no significant differences between the two groups for the survival （P=0.496）.ConclusionCompared with bipolar lead group, the burden of VA could be significantly reduced after CRT-D in the quadripolar lead group.