右心室导线位置对心脏再同步治疗效果的影响

Impact of right ventricular lead position on cardiac resynchronization therapy efficacy

目的 与右心室心尖部（RVA）起搏相比,右心室中位间隔部（RVMS）起搏能否进一步提高心脏再同步治疗（CRT）的效果.方法 选取安徽省立医院2010年1月至2015年6月植入心脏再同步治疗起搏器/除颤器（CRT-P/D）的患者386例,根据右心室导线植入位置,分为RVMS组（155例）和RVA组（231例）,比较两组患者术后6个月超声心动图、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心室射血分数（LVEF）、收缩期不同步指数（SDI）、心电图QRS时限以及心功能改善情况.随访至12个月,比较两组患者心力衰竭再住院率及全因死亡率差异.结果 术后6个月RVMS组与RVA组比较,LVEDV缩小[（19.43±12.19） ml对（20.19±12.88） ml,P=0.56],LVESV缩小[（35.9± 21.5） ml对（36.6± 22.9） ml,P=0.77],LVEF改善[（8.94%± 5.42%）对（8.75%± 5.51%）, P=0.74]RVMS组和RVA组的治疗有效率差异无统计学意义（62%对60%,P=0.58）.RVMS 组和RVA组临床症状均显著改善,心功能（NYHA分级）也改善[（1.01±0.37）对（1.10±0.36）,P=0.42].随访12个月,两组患者心力衰竭再住院率/全因死亡率差异无统计学意义（16.8%对19.5%,P=0.50）.结论 与RVA相比,RVMS并不能提高CRT的同步性,改善临床症状及预后.

Objective To investigate if right ventricular middle septum（RVMS）could further improve the treatment effects compared with right ventricular apex（RVA） in the patients receiving cardiac resynchroni-zation therapy（CRT）. Methods A total of 386 CRT-P/D patients were enrolled in this study between January 2001 and June 2015.The enrolled patients were divided into two groups based on the RV lead location,RVMS 155 and RVA 231.At 6-month follow-up the Echocardiographic characteristics were compared,including left ventricular end-diastolic volume（LVEDV）,left ventricular end-systolic volume（LVESV）,left ventricular ejec-tion fraction（LVEF）,systolic dyssynchrony index（SDI）,QRS duration,and clinical outcomes were compared too.The time to first HF hospitalization or death were recorded in 12 moths. Results After 6-month RVMS group was compared with RVA group,there were no significant differences in reduction of LVESV[（19.43＋12.19） ml vs.（20.19＋12.88） ml,P=0.56]、LVESV[（35.9＋21.5） ml vs.（36.6＋22.9） ml,P=0.77], or improvement of LVEF（8.94%＋5.42% vs. 8.75%＋5.51%,P=0.74）.The reductiong of LVESV〉15%was similar in both groups（RVMS 60% vs. RVA 62%,P=0.58）,the NYHA improved in both group（1.01＋0.37 vs. 1.10＋0.36,P=0.42）,but the difference was not statistically significant.The first HF hospitaliza-tion or death was 16.8% in RVMS group and 19.5% in RVA group）with no significantly difference between the two groups in 12 moths（P=0.50）. Conclusions Compared with RVA,RVMS could not improve cardi-ac systolic synchrony、clinical symptoms and prognosis furthermore.