左心室四级导线及Smart Delay对心脏再同步治疗安全性影响

Influence of left ventricular quadripolar leads and Smart Delay on safety of cardiac resynchronization therapy

目的探讨左心室四级导线及Smart Delay对心脏再同步治疗安全性影响。方法选取延安大学附属医院2018年1月至2019年12月行心脏再同步治疗的30例患者作为研究对象,按病情分为双极导线组(n=10)与四级导线组(n=20),双极导线组患者在心脏再同步化治疗时选择双极导线,四级导线组患者在心脏再同步化治疗中选择四级导线,对比两组患者的左室导线植入时间、植入部位、起搏向量选择、心电图QRS宽度、NYHA心功能分级及术后随访1.5~2年并发症发生情况。将植入有Smart DelayTM计算功能的四级导线心脏在同步治疗的20例患者中又分为两个亚组,即CRT优化组(n=10)和常规优化组(n=10),分别进行CRT自动优化与常规二维超声、多普勒等优化,在术后1、3、6月和1年分别回访,观察超声优化与设备自身优化后,两组患者的CRT反应性。结果两组患者置入时间、左室起搏位点的基底段与中间段、靶血管位置、靶血管长度对比无明显差异(P>0.05),两组患者的心尖段左室起搏位点、可选择向量对比差异显著(P<0.05);对两组患者在术后6个月的时候随访发现,心功能改善情况、CRT有反应、NYHA心功能分级、QRS波时限、LVEF对比差异显著(P<0.05),LVEDd对比无显著差异(P>0.05);术后1.5~2年随访发现,双极导线组患者的并发症发生率明显高于四级导线组,差异具有统计学意义(P<0.05);Smart Delay自动优化组与常规超声优化组患者术后1、3、6个月、1年随访的左室阈值、CRT有反应情况、NYHA心功能分级对比无明显差异(P>0.05)。结论通过短期随访发现左心室四级导线对患者的心脏功能与安全性明显高于双极导线,CRT自动优化与多普勒、常规超声二维优化无显著性差异。

Objective To discuss the influence of left ventricular quadripolar leads and Smart Delay on the safety of cardiac resynchronization therapy(CRT).Methods The patients undergone CRT(n=30)were chosen and divided randomly into bipolar-lead group(n=10)and quadripolar-lead group(n=20)from Affiliated Hospital of Yan`an University from Jan.2018 to Dec.2019.The bipolar leads were chosen in bipolar-lead group and quadripolar leads were chosen in quadripolar-lead group during CRT.The time and position of left ventricular lead implantation,pacing vector selection,QRS width in ECG and NYHA classification of heart function were compared,and incidence of complications was followed up for 1.5 y to 2 y in 2 groups.The patients undergone CRT implanted by quadripolar leads with Smart DelayTM calculation function(n=20)were divided randomly into CRT optimization group given CRT automatic optimization and routine optimization group given routine optimizations of 2-dimentional ultrasound and Doppler(each n=10).The reactivity was observed in patients in 2 groups after ultrasound optimization and CRT automatic optimization after followed up for 1 month,3 and 6 months and 1 y.Results The comparison in time of implantation,basal segment and middle segment of left ventricular pacing sites and target vessel position and length had no significant difference between 2 groups(P>0.05).The difference in left ventricular pacing site of apical segment and optional vector had significance between 2 groups(P<0.05).After followed up for 6 months,the comparison in heart function improvement,CRT response,NYHA classification of heart function,QRS wave duration and LVEF had significant difference(P<0.05),and comparison in LVEDd had no significant difference(P>0.05)between 2 groups.After followed up for 1.5 y to 2 y,the incidence rate of complications was significantly higher in bipolar-lead group than that in quadripolar-lead group(P<0.05).The comparison in left ventricular threshold,CRT response and NYHA classification of heart function had no significant difference between CRT optimization group and routine optimization group after followed up for 1 month,3 and 6 months and 1 y(P>0.05).Conclusion Through short-term follow-up,it was found that the left ventricular fourth-level lead has significantly higher cardiac function and safety than bipolar lead.There is no significant difference between CRT automatic optimization and Doppler and conventional ultrasound two-dimensional optimization.