Background Cardiac resynchronization therapy （CRT） with biventricular pacing improves cardiac function,functional capacity and quality of life in selected patients with heart failure.The current study aimed to evalu...Background Cardiac resynchronization therapy （CRT） with biventricular pacing improves cardiac function,functional capacity and quality of life in selected patients with heart failure.The current study aimed to evaluate the efficacy of the intracardiac electrogram （IEGM）-based optimization method,QuickOptTM,in Chinese patients treated with CRT.Methods Aortic time velocity integrals （AVTI） achieved at the sensed atrioventricular （AV）,paced AV and interventricular （VV） interval settings recommended by both QuickOptTM and standard echocardiographic optimization were measured in 101 patients.Consistency and the strength of the relationship between the two timing cycle optimization methods were assessed by intra-class correlation coefficient （ICC）.Results The ICC showed good agreement and correlation with what the AVTI achieved at the optimal sensed AV （ICC=0.9683 （0.9535-0.9785））,paced AV （ICC=0.9642 （0.9475-0.9757）） and VV （ICC=0.9730 （0.9602-0.9817）） interval settings determined by the two optimization methods.The average time required by echocardiographic optimization and by QuickOptTM were （78.32±32.40） minutes and （1.98±1.64） minutes respectively （P 〈0.0001）.Conclusion The QuickOptTM algorithm provides a quicker,simpler and reliable alternative to the standard method for timing cycle optimization.（ClinicaITrial.gov Reference Number：NCT00918294）展开更多
Background: The optimal site for left ventricular (LV) lead placement in cardiac resynchronization therapy (CRT) remains uncertain. Intra-procedural measures for predicting response to CRT have shown mixed results. Hy...Background: The optimal site for left ventricular (LV) lead placement in cardiac resynchronization therapy (CRT) remains uncertain. Intra-procedural measures for predicting response to CRT have shown mixed results. Hypothesis: This study analyzed intracardiac electrogram (IEGM) characteristics at implant and assessed patients’ response rates (RR) to CRT. Methods: Forty-one consecutive patients undergoing CRT were enrolled. Medically optimized patients in sinus rhythm, with ejection fraction (EF) 34 were included. Right ventricular (RV) leads were positioned mid-septum. LV leads were targeted to the latest mechanical activation on echocardiography. IEGMs were measured, assessing intrinsic RV-to-LV delay (int RV-LV), RV-paced delay (RVp-LV), and LV-paced delay (LVp-RV). The difference between LVp-RV and RVp-LV was recorded as delta-LV. Response was defined as improvement of EF > 10%, reduction in LVEDD > 15% and improvement of ≥1 NYHA class. Results: Overall RR was 79%. LV leads were placed in the target location in 91%. Int RV-LV was 101 ± 14 ms in responders;78 ± 11 ms in non-responders (p 100 had a RR of 87%;int RV-LV 40 ms had a RR of 56%;delta-LV < 40 ms had a RR of 85%. There was no significant correlation between lead position, DI, QRS duration or EF and IEGM measurements. Conclusions: IEGM measures at implant are easily obtained. Significant intrinsic electrical delay and shorter delta-LV both predict response, even when LV leads are implanted in the targeted mechanically-delayed segment. These assessments of electrical dyssynchrony may be used to determine optimal lead positions and response to CRT.展开更多
采用冠状窦和二尖瓣环单极记录标测左侧显性旁道和确定消融靶点指导射频消融治疗20例预激综合征。同步记录多部位冠状窦单极电图均清楚显示房波(UP)和室波(UR),其旁道定位点表现为 UP 降支和 UR 起始几乎融合构成特征性的复合波——PQS ...采用冠状窦和二尖瓣环单极记录标测左侧显性旁道和确定消融靶点指导射频消融治疗20例预激综合征。同步记录多部位冠状窦单极电图均清楚显示房波(UP)和室波(UR),其旁道定位点表现为 UP 降支和 UR 起始几乎融合构成特征性的复合波——PQS 波,而远离旁道的单极电图显示 UP 和 UR 分离构成 P—QS 或 P—rS 波。二尖瓣环单极记录时其图形变化类同冠状窦。比较冠状窦标测点和二尖瓣环单极电图的图形特征能迅速、直观地确定消融靶点。展开更多
文摘Background Cardiac resynchronization therapy （CRT） with biventricular pacing improves cardiac function,functional capacity and quality of life in selected patients with heart failure.The current study aimed to evaluate the efficacy of the intracardiac electrogram （IEGM）-based optimization method,QuickOptTM,in Chinese patients treated with CRT.Methods Aortic time velocity integrals （AVTI） achieved at the sensed atrioventricular （AV）,paced AV and interventricular （VV） interval settings recommended by both QuickOptTM and standard echocardiographic optimization were measured in 101 patients.Consistency and the strength of the relationship between the two timing cycle optimization methods were assessed by intra-class correlation coefficient （ICC）.Results The ICC showed good agreement and correlation with what the AVTI achieved at the optimal sensed AV （ICC=0.9683 （0.9535-0.9785））,paced AV （ICC=0.9642 （0.9475-0.9757）） and VV （ICC=0.9730 （0.9602-0.9817）） interval settings determined by the two optimization methods.The average time required by echocardiographic optimization and by QuickOptTM were （78.32±32.40） minutes and （1.98±1.64） minutes respectively （P 〈0.0001）.Conclusion The QuickOptTM algorithm provides a quicker,simpler and reliable alternative to the standard method for timing cycle optimization.（ClinicaITrial.gov Reference Number：NCT00918294）
文摘Background: The optimal site for left ventricular (LV) lead placement in cardiac resynchronization therapy (CRT) remains uncertain. Intra-procedural measures for predicting response to CRT have shown mixed results. Hypothesis: This study analyzed intracardiac electrogram (IEGM) characteristics at implant and assessed patients’ response rates (RR) to CRT. Methods: Forty-one consecutive patients undergoing CRT were enrolled. Medically optimized patients in sinus rhythm, with ejection fraction (EF) 34 were included. Right ventricular (RV) leads were positioned mid-septum. LV leads were targeted to the latest mechanical activation on echocardiography. IEGMs were measured, assessing intrinsic RV-to-LV delay (int RV-LV), RV-paced delay (RVp-LV), and LV-paced delay (LVp-RV). The difference between LVp-RV and RVp-LV was recorded as delta-LV. Response was defined as improvement of EF > 10%, reduction in LVEDD > 15% and improvement of ≥1 NYHA class. Results: Overall RR was 79%. LV leads were placed in the target location in 91%. Int RV-LV was 101 ± 14 ms in responders;78 ± 11 ms in non-responders (p 100 had a RR of 87%;int RV-LV 40 ms had a RR of 56%;delta-LV < 40 ms had a RR of 85%. There was no significant correlation between lead position, DI, QRS duration or EF and IEGM measurements. Conclusions: IEGM measures at implant are easily obtained. Significant intrinsic electrical delay and shorter delta-LV both predict response, even when LV leads are implanted in the targeted mechanically-delayed segment. These assessments of electrical dyssynchrony may be used to determine optimal lead positions and response to CRT.
文摘采用冠状窦和二尖瓣环单极记录标测左侧显性旁道和确定消融靶点指导射频消融治疗20例预激综合征。同步记录多部位冠状窦单极电图均清楚显示房波(UP)和室波(UR),其旁道定位点表现为 UP 降支和 UR 起始几乎融合构成特征性的复合波——PQS 波,而远离旁道的单极电图显示 UP 和 UR 分离构成 P—QS 或 P—rS 波。二尖瓣环单极记录时其图形变化类同冠状窦。比较冠状窦标测点和二尖瓣环单极电图的图形特征能迅速、直观地确定消融靶点。
