左室电极起搏位置与心脏再同步化治疗的疗效

摘要

Objective To observe the effect of left ventricular(LV) lead pacing position on long-term outcome of cardiac resynchronization therapy (CRT) in patients with chronic heart failure (CHF). Methods One hundred and ten consecutive patients with CHF were implanted with a CRT device according to standard clinical indication. LV lead implantation position was categorized as anterior,lateral,posterior and postero-basic wall using both the postero-anterior and the left anterior oblique postoperative chest radiographs. All patients were followed for at least 12 months. After 12 months of CRT operation, the NYHA functional class, QRS width, left ventricular ejection fraction ( LVEF) and other ultrasound indexes were analysed. Clinical response, defined by a 151 NYHA functional class reduction or LVEF increasing 25%. Results Due to cardiac vein anatomic variables and the examination of tissue doppler imaging(TDI), LV lead of 110 patients were individually into anterior (n = 4 ) , lateral ( n = 68), posterior (n = 37) and posterior-base (n = 1). During a follow-up of 12 months,6 patients died including 2 patients suffered from sudden death, 1 patient categorized as serious pneumonia,3 patients attributed to heart failure worsening. After 12 months of CRT operation, the proportion of the 104 survivors responding to CRT is 87.5% , Clinic response was higher in patients with lateral(92.4% ) versus posterior(87.5% ) lead position( P < 0.05). Conclusions CRT is an effective treatment for CHF in a long-term. The long-term outcome of CRT is associated with LV lead stimulation site. LV lateral or posterior wall is optimal for lead position. [ Chinese Journal of Cardiac Pacing and Electrophysiology,2011,25(4) :306 -309]%目的 探讨左室电极在左室游离壁不同位置起搏对慢性心力衰竭（简称心衰）心脏再同步化治疗(CRT)患者远期疗效的影响.方法 110例扩张型心肌病或高血压病合并慢性左心衰患者均符合CRT植入指征而接受CRT术,术后根据后前位和左前斜位的胸部X线影像,左室电极导线植入部位分为前壁、侧壁、后壁和后基底部.术后12个月,分别查心脏超声、心电图等,分析心功能、心电图QRS波时限和左室射血分数(LVEF)及左室容积变化.以心功能(NYHA)分级至少改善l级或LVEF升高25％以上定义为有效.结果 由于患者心脏静脉变异和组织超声多普勒检查结果,左室电极导线分别被植入前壁4例、侧壁68例和后壁37例、后基底部1例.术后3例因心功能恶化死亡,2例发生猝死,l例术后第9天因肺部感染死亡.术后12个月,104例生存者中,有效91例,无效13例,总有效率87.5％.左室电极位于侧壁组的有效率(92.4％)明显高于后壁组(85.7％)(P＜0.05).前壁或后基底部的5例均无效.结论 CRT对慢性心衰患者有效,其疗效与左室电极起搏位置密切相关,左室侧壁或后壁是左室电极导线的理想起搏部位.