在心脏再同步治疗中确定感知和节奏心房延迟
Alan J Bank1,2, Christopher D Brown1, Kevin V Burns1,2
1Research Department, Minneapolis Heart Institute East at United Hospital, St. Paul, Minnesota, USA.
Pacing and clinical electrophysiology : PACE
|March 13, 2024
概括
优化心房心室延迟 (AVD) 改善了心脏再同步治疗 (CRT). 一种新的心电图方法量化了在左心室 (LV) 节奏中为最佳AVD设置的电同步,显示较短的延迟增强了双心室节奏中的同步.
科学领域:
- 心脏病学 心脏病学
- 生物医学工程 生物医学工程
- 电子生理学 电子生理学
背景情况:
- 优化心房心室延迟 (AVD) 是有效的心脏再同步治疗 (CRT) 的关键.
- 目前优化AVD设置 (SAVD和PAVD) 的方法可能很复杂.
- 提出了一种新的心电图学方法来改进AVD优化.
研究的目的:
- 引入和验证一种用于量化电同步的新型心电图学方法.
- 在心脏再同步疗法 (CRT) 进行心脏感应 (SAVD) 和节奏 (PAVD) 期间优化心房心室延迟 (AVD) 设置.
- 为了比较在左心室 (LV) 节奏和双心室 (BiV) 节奏期间与不同的AVD设置实现的电同步.
主要方法:
- 研究了40名具有LV激活延迟的CRT患者.
- 从心内电图测量了心房传感到RV传感 (As-RVs) 和心房节奏到RV传感 (Ap-RVs) 的间隔.
- 评估了使用心脏重同步指数 (CRI) 来评估的电动失同,该指数来自于在LV-only节奏和BiV节奏与不同AVDs期间的多轴心心心电图系统.
主要成果:
- 在心房传感或步调与LV-only步调时,峰值CRI类似,但最佳PAVD明显大于最佳SAVD (61±31 ms).
- As-RVs和Ap-RVs间隔之间的差异与最佳的SAVD-PAVD偏移非常接近.
- 在 BiV 节奏与短 AVD, SAVD 和 PAVD 编程期间没有显著影响 CRI,但在心房传感期间较长的 AVD 减少了 CRI.
结论:
- 一种新的心电图方法有效地确定了在LV-only节奏时的最佳SAVD/PAVD.
- 在双心脏节奏过程中较短的AVD会导致更好的电同步.
- 这种方法为优化CRT设备设置提供了一种新的方法,以改善患者的治疗结果.
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