左心室起搏电极位置对CRT治疗慢性心力衰竭患者临床指标和预后的影响

Impacts of left ventricular pacing electrode position on clinical indices and prognosis of patients with chronic heart failure treated by CRT

目的分析左心室起搏电极位置对CRT治疗慢性心力衰竭患者临床指标和预后的影响。方法回顾分析钟祥市人民医院心血管内科2017年3月至2020年2月120例成功植入CRT-P/D的慢性心力衰竭患者,根据左心室电极在左前斜45°(LAO 45°)和右前斜30°(RAO 30°)将左心室起搏电极位置分为前壁组(n=47)与后侧壁组(n=73)两组以及基底组(n=45)、中间组(n=50)、心尖组(n=25)三组。比较患者术后6个月心功能指标、反应性和预后情况。结果术后后侧壁组患者的dQRS、LVEDD、LVESV低于前壁组,差异有统计学意义(P<0.05);后侧壁组术后总反应率高于前壁组,差异有统计学意义(P<0.05)。术后基底组、中间组的LVEDD、dQRS低于心尖组,差异有统计学意义(P<0.05);基底组、中间组的LVEF高于心尖组,差异有统计学意义(P<0.05);基底组、中间组、心尖组术后6个月总反应率比较,差异无统计学意义(P>0.05)。结论CRT治疗慢性心力衰竭,左心室起搏电极放在左心室后侧壁非心尖区临床疗效更好。

Objective To investigate the impacts of left ventricular pacing electrode position on clinical indices and prognosis of patients with chronic heart failure treated by cardiac resynchronization therapy(CRT).Methods A total of 120 patients with chronic heart failure who successfully implanted CRT-P/D in the department of cardiovascular medicine of Zhongxiang People’s Hospital from March 2017 to February 2020 were retrospectively investigated.According to the left ventricular electrodes’left anterior oblique angle of 45°(LAO 45°)and right anterior oblique angle of 30°(RAO 30°),the left ventricular pacing electrode positions were divided into two groups as the anterior wall group(n=47)and the posterior wall group(n=73),and three groups as the basal group(n=45),the intermediate group(n=50)and the apical group(n=25).The indices of cardiac function,responsiveness and prognosis were compared 6 months after operation.Results After operation,the dQRS,LVEDD and LVESV of patients in the posterior wall group were lower than those in the anterior wall group,with statistically significant differences(P<0.05).The postoperative responsiveness of the posterior wall group was higher than that of the anterior wall group,with statistically significant difference(P<0.05).After operation,the LVEDD and dQRS in the basal group and the intermediate group were lower than those in the apical group,with statistically significant differences(P<0.05).The LVEF of the basal group and the intermediate group were higher than that of the apical group,with statistically significant differences(P<0.05).There was no significant difference in the total response rate of basal group,intermediate group and apical group at 6 months after operation(P>0.05).Conclusion In the treatment of chronic heart failure with CRT,the left ventricular pacing electrode placed in the non-apical area of the posterior wall of the left ventricle has better clinical efficacy.