起搏融合自身传导程序在心脏再同步治疗中的应用及疗效评价

Clinical application and evaluation of SyncAV algorithm in cardiac resynchronization therapy

目的评价起搏融合自身传导(SyncAV)程序在心脏再同步治疗(CRT)中的疗效及优势。方法自2018年1月至2019年12月连续收集在复旦大学附属中心医院心内科植入带有SyncAV功能的CRT或心脏再同步治疗除颤器(CRT-D)患者,将其随机分为对照组(关闭SyncAV功能)和SyncAV组(打开SyncAV功能)。术前评估心功能,行12导联心电图及超声心动图检查,测得QRS时限(QRSd)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)和左心室射血分数(LVEF)等参数。术后6个月随访再次评估上述各项指标。结果共入组65例左束支传导阻滞(LBBB)且房室传导正常的患者,对照组33例,SyncAV组32例。对照组中25例患者左心室导线植入侧后静脉,SyncAV组中26例植入侧后静脉(75.8%对81.3%,P>0.05)。SyncAV组患者起搏QRSd显著短于对照组[(137.3±13.1)ms对(144.8±12.2)ms,P<0.05]。术后6个月随访,SyncAV组患者LVEDD[(61.7±12.3)mm对(67.7±9.9)mm,P<0.05]、LVESD[(49.5±13.0)mm对(56.0±11.1)mm,P<0.05]较对照组显著缩小,而LVEF显著增加(43.8%±9.6%对36.7%±6.2%,P<0.01)。与基线状态比较,SyncAV功能较传统双心室起搏进一步缩短QRSd[(-29.1±12.5)ms对(-20.0±11.9)ms,P<0.01],减小LVEDD[(-8.6±8.7)mm对(-3.6±6.7)mm,P<0.05]和LVESD[(-11.1±10.0)mm对(-5.5±7.3)mm,P<0.05],提高LVEF(15.9%±8.2%对9.0%±3.7%,P<0.01)。结论对伴有LBBB和房室传导正常的患者,SyncAV程序较传统双心室起搏可进一步改善电同步性和心脏功能。

Objective To investigate the benefits of a novel,device-based SyncAV algorithm in cardiac resynchronization therapy(CRT).Methods From January 2018 to December 2019,patients undergoing CRT or CRT defibrillator(CRT-D)implantation in Department of Cardiology,Zhongshan Hospital of Fudan University were recruited and randomized to control group and SyncAV group,with the SyncAV algorithm OFF and ON,respectively.New York Heart Association(NYHA)functional grading,12-lead electrocardiographic QRS duration(QRSd),echocardiographic parameters including left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD)and left ventricular ejection fraction(LVEF)were measured before and 6 months after implantation.Results A total of 65 patients with intact atrioventricular conduction and left bundle branch block(LBBB)were enrolled,in whom 33 cases were programmed to SyncAV OFF and 32 cases programmed to SyncAV ON.Twenty-five subjects had the left ventricular(LV)lead positioned in posterolateral vein in control group while 26 subjects in SyncAV group(75.8%vs.81.3%,P>0.05).A significantly shorter paced QRSd was observed in SyncAV group than that in control group[(137.3±13.1)ms vs.(144.8±12.2)ms,P<0.05].At the 6-month follow-up,patients in SyncAV group showed significantly smaller LVEDD[(61.7±12.3)mm vs.(67.7±9.9)mm,P<0.05],LVESD[(49.5±13.0)mm vs.(56.0±11.1)mm,P<0.05]and higher LVEF(43.8%±9.6%vs.36.7%±6.2%,P<0.01)than in control group.Compared with nominal biventricular setting(SyncAV OFF),SyncAV algorithm offered further QRSd decrease[(-29.1±12.5)ms vs.(-20.0±11.9)ms,P<0.01],LVEDD reduction[(-8.6±8.7)mm vs.(-3.6±6.7)mm,P<0.05],LVESD reduction[(-11.1±10.0)mm vs.(-5.5±7.3)mm,P<0.05],and LVEF elevation(15.9%±8.2%vs.9.0%±3.7%,P<0.01)relative to intrinsic conduction.Conclusion SyncAV algorithm improved acute electrical synchrony and mid-term cardiac function beyond conventional CRT in patients with LBBB.