Background: Up to one in three patients implanted with a cardiac resynchronization therapy-defibrillator (CRT-D) device experience phrenic nerve stimulation (PNS). Quadripolar leads are effective at reducing PNS, but ...Background: Up to one in three patients implanted with a cardiac resynchronization therapy-defibrillator (CRT-D) device experience phrenic nerve stimulation (PNS). Quadripolar leads are effective at reducing PNS, but compared to standard bipolar leads they have limitations related to maneuverability and high pacing thresholds. The ability of standard bipolar leads to overcome PNS is explored here. Methods: The French multicenter, observational study ORPHEE enrolled 90 CRT-D-eligible patients. Detection of PNS took place after satisfactory positioning of the LV bipolar lead (stable pacing threshold - LV ring, LV tip - RV ring and LV ring - RV coil) could prevent PNS from occurring in at least 90% of patients. Results: In 80 evaluable patients, PNS was reported in 12 patients (15%). Reprogramming overcame PNS in 10 patients: LV ring - RV coil in 8 patients;LV tip - LV ring in 1;and LV tip- RV ring in 1. As PNS was avoided in 78 of 80 patients (97.5%), the primary endpoint was significant (97.5% vs. 90%, p = 0.01). Conclusion: During CRT-D implantation, PNS occurred in 15% of patients. In most (97.5%) implanted patients, PNS could be avoided by vector reprogramming using a bipolar LV lead. For patients whose coronary sinus anatomy precludes the implantation of multi-electrode leads, bipolar leads are a suitable, reliable alternative.展开更多
目的通过对已发表的随机对照研究和观察性研究进行Meta分析,评价心脏再同步化治疗植入左室四极电极导线与双极电极导线的结局有无明显差异。方法检索Pubmed、Embase、Cochrane Central Register of Controlled Trials(CENTRAL)、Web Of ...目的通过对已发表的随机对照研究和观察性研究进行Meta分析,评价心脏再同步化治疗植入左室四极电极导线与双极电极导线的结局有无明显差异。方法检索Pubmed、Embase、Cochrane Central Register of Controlled Trials(CENTRAL)、Web Of Science、CNKI、万方、维普数据库。检索时限为建库至2017年6月30日,检索完成后按纳入排除标准纳入研究、提取资料和质量评价后,应用Rev Man5.3软件进行Meta分析。结果共纳入10项研究,包含28 196例患者。Meta分析显示,与心脏再同步化治疗患者植入传统双极电极导线相比,植入左室四极电极导线可显著减少术后电极导线更换、移位、无效及手术修正的情况发生(OR=0.53,95%CI:0.44~0.63,P<0.00001);在经程控后能更好的消除膈神经刺激(OR=0.21,95%CI:0.09~0.50,P=0.0004);全因死亡事件明显减少(OR=0.60,95%CI:0.54~0.67,P<0.00001);心力衰竭(心衰)住院事件同样明显减少(OR=0.34,95%CI:0.16~0.75,P=0.007)。结论心脏再同步化治疗植入左室四极电极在电极导线更换、移位、无效及手术修正,膈神经刺激,全因死亡事件和心衰住院事件方面均优于传统双极电极,可显著改善患者对心脏再同步化治疗反应性、提高疗效以及生活质量。展开更多
文摘Background: Up to one in three patients implanted with a cardiac resynchronization therapy-defibrillator (CRT-D) device experience phrenic nerve stimulation (PNS). Quadripolar leads are effective at reducing PNS, but compared to standard bipolar leads they have limitations related to maneuverability and high pacing thresholds. The ability of standard bipolar leads to overcome PNS is explored here. Methods: The French multicenter, observational study ORPHEE enrolled 90 CRT-D-eligible patients. Detection of PNS took place after satisfactory positioning of the LV bipolar lead (stable pacing threshold - LV ring, LV tip - RV ring and LV ring - RV coil) could prevent PNS from occurring in at least 90% of patients. Results: In 80 evaluable patients, PNS was reported in 12 patients (15%). Reprogramming overcame PNS in 10 patients: LV ring - RV coil in 8 patients;LV tip - LV ring in 1;and LV tip- RV ring in 1. As PNS was avoided in 78 of 80 patients (97.5%), the primary endpoint was significant (97.5% vs. 90%, p = 0.01). Conclusion: During CRT-D implantation, PNS occurred in 15% of patients. In most (97.5%) implanted patients, PNS could be avoided by vector reprogramming using a bipolar LV lead. For patients whose coronary sinus anatomy precludes the implantation of multi-electrode leads, bipolar leads are a suitable, reliable alternative.
文摘目的通过对已发表的随机对照研究和观察性研究进行Meta分析,评价心脏再同步化治疗植入左室四极电极导线与双极电极导线的结局有无明显差异。方法检索Pubmed、Embase、Cochrane Central Register of Controlled Trials(CENTRAL)、Web Of Science、CNKI、万方、维普数据库。检索时限为建库至2017年6月30日,检索完成后按纳入排除标准纳入研究、提取资料和质量评价后,应用Rev Man5.3软件进行Meta分析。结果共纳入10项研究,包含28 196例患者。Meta分析显示,与心脏再同步化治疗患者植入传统双极电极导线相比,植入左室四极电极导线可显著减少术后电极导线更换、移位、无效及手术修正的情况发生(OR=0.53,95%CI:0.44~0.63,P<0.00001);在经程控后能更好的消除膈神经刺激(OR=0.21,95%CI:0.09~0.50,P=0.0004);全因死亡事件明显减少(OR=0.60,95%CI:0.54~0.67,P<0.00001);心力衰竭(心衰)住院事件同样明显减少(OR=0.34,95%CI:0.16~0.75,P=0.007)。结论心脏再同步化治疗植入左室四极电极在电极导线更换、移位、无效及手术修正,膈神经刺激,全因死亡事件和心衰住院事件方面均优于传统双极电极,可显著改善患者对心脏再同步化治疗反应性、提高疗效以及生活质量。
