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在CRT非响应者中升级到LBBP的结果:一个前性,多中心,非随机的,病例对照研究

Xueying Chen¹, Qinchun Jin¹, Zhaohui Qiu²

¹Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China.

JACC. Clinical electrophysiology

|November 9, 2023

概括

升级到左束分支节奏 (LBBP) 是对心脏再同步治疗 (CRT) 无反应者的可行和有效的策略,显著改善了心脏功能和临床结果. 这种方法为那些无法从传统CRT中受益的患者提供了一个有希望的替代方案.

科学领域:

心脏病学心脏病学
电子生理学电子生理学
医疗器械医疗器械

背景情况:

心脏再同步治疗 (CRT) 是心力衰竭的治疗方法,但大约30%的候选人没有反应.
左捆分支节奏 (LBBP) 为CRT不响应者提供了一个替代的节奏策略.

研究的目的:

评估升级CRT对LBBP无反应者的可行性和临床疗效.
评估LBBP在该患者群体中的长期临床结果,使用倾向-得分匹配 (PSM).

主要方法:

招募了145名CRT无响应者,并随机分配到升级到LBBP (n=48) 或继续双心脏节奏 (BVP) (n=97).
倾向-得分匹配 (PSM) 用于1:1对比组之间的比较.
在基线和随访时进行了临床和心声学评估. 主要综合终点包括心力衰竭再住院,全因死亡或心脏移植.

主要成果:

97.96%的患者成功升级了LBBP,QRS持续时间显著减少.
6个月和12个月后,LBBP显著增加了左心室喷射率 (LVEF) (47.73%的响应率),而BVP组没有改善.
在平均24个月的随访期间,LBBP组的初级复合终点 (HR:0.31;P=0.007) 发生率明显较低.

结论:

升级到LBBP是CRT不响应者可行的和有效的策略.
与持续的BVP相比,LBBP导致心脏功能显著改善和更好的临床结果.
对于CRT不响应的患者来说,LBBP是一个有前途的替代节奏策略.

关键词:

双心室节奏是指双心室节奏.心脏再同步治疗心脏再同步治疗左捆的分支节奏节奏,分支节奏.响应响应响应响应

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