心室内膜优化改善了长时间内膜间电延迟患者的心脏再同步反应:对SMART-AV和SMART-CRT试验的综合分析
Michael R Gold1, Angelo Auricchio2, Christophe Leclercq3
1Medical University of South Carolina, Charleston, South Carolina.
Heart rhythm
|April 11, 2024
概括
使用SmartDelay进行心室内膜优化 (AVO) 改善了心脏再同步治疗 (CRT) 响应,患者心室内膜延迟≥70毫秒. 这种方法提高了与固定AV延迟相比的反向改造.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 临床试验 临床试验
背景情况:
- 对于心脏再同步治疗 (CRT) 的心房心脏优化 (AVO) 算法的有效性仍在争论中.
- 之前的研究表明,患有长期腹腔间延迟 (≥70毫秒) 的患者可能受益于AVO.
研究的目的:
- 用SmartDelay算法重新评估AVO的实用性,用于CRT指示和间延迟≥70毫秒的患者.
- 通过汇集来自SMART-AV和SMART-CRT试验的数据来增加统计能力.
主要方法:
- 从前性,随机的SMART-AV和SMART-CRT试验中收集了451名患者的数据.
- 患者被随机分配到AVO (智能延迟) 或固定AV延迟 (120毫秒).
- CRT反应被定义为左心室末缩体积≥15%的减少,通过心声回声学评估.
主要成果:
- 与固定AV延迟组 (63.1%;P = .014) 相比,AVO组 (SmartDelay) 的CRT响应者比例显著更高 (73.9%).
- 接受SmartDelay治疗的患者在反向重塑指标上表现出更大的改善.
- 当推的感知AV延迟在100-120毫秒范围之外时,SmartDelay的使用与CRT响应的几率增加了2.3倍.
结论:
- 与固定的AV延迟相比,SmartDelay编程导致了更大的CRT响应和反向重塑.
- 这些发现支持SmartDelay在接受CRT的患者中使用,其间静脉延迟≥70 ms.
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