左束枝ブロックパターンの心内導導管の線引き
Gaurav A Upadhyay1, Tharian Cherian1, Dalise Y Shatz1
1The University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Section of Cardiology, IL.
Circulation
|February 2, 2019
まとめ
この研究は,左束の枝の完全な伝導ブロックが,左束の枝のブロック (LBBB) パターンの患者で一般的であることを明らかにしています. 彼のバンドルペースは 患者のQRS期間を 効果的に修正します 特にブロックが内側にある場合です
科学分野:
- 心臓病科
- 電気生理学
- 心臓伝導システム
背景:
- 左ブンドルブランチブロック (LBBB) の患者における Septal活性化パターンはこれまで詳細に示されていない.
- His-Purkinjeシステム内の伝導ブロックを理解することは,LBBBの管理に不可欠です.
研究 の 目的:
- LBBBの患者の左束の枝に完全な伝導ブロック (CCB) の存在と位置を調査する.
- これらの患者におけるHis バンドル・ペーシングの有効性を評価する.
主な方法:
- LBBBパターンと対照群の85人の患者で,マルチエレクトロドカテーテルを用いた心内マッピング.
- QRSの幅,HISの持続時間,HIS-心室間隔,そして隔膜伝導パターンの分析.
- CCBの患者およびそれ以外の患者におけるHis バンドルペースの反応の評価
主要な成果:
- 完全な伝導ブロック (CCB) は,LBBB患者の64%で発見され,しばしば左側内垂体または左側近垂体支部に位置していました.
- LBBB患者の54%で幅広いQRSを修正し,CCB患者の成功率は85%でした.
- 心内CCBの検出は,ペース反応の表面EKGよりも高い予測値を示した.
結論:
- LBBBのセプト伝導は異質で,CCBは左のHis繊維内で頻繁に観察される.
- 左脳内膜のブロックは 潜伏のパーキンジェ線維による ヒース・バンドル・ペーシングに 特に反応します
- 内心マッピングは,表面EKGの基準と比較して再同期療法に対する患者の選択を改善する可能性があります.
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