心脏再同步疗法通过左捆分支节奏在心力衰竭与完整的左捆分支阻断的心脏再同步疗法:是否需要除器?
Dandan Yang1,2, Qunchao Ma1,2, Hong Zhu1
1Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Frontiers in cardiovascular medicine
|January 30, 2025
概括
双室左束枝节奏 (LBBP) 在完全左束枝节阻塞 (CLBBB) 和心力衰竭的患者中显著改善了心脏功能. 这种疗法提供了CRT-D的替代方案,可能可以避免ICD植入.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 心脏衰竭管理的管理
背景情况:
- 在心力衰竭患者中,完整的左捆分支阻塞 (CLBBB) 通常需要心脏再同步治疗 (CRT-D).
- 左束枝节奏 (LBBP) 是一种新兴的左心室节奏技术.
- 对于特定心力衰竭人群来说,研究LBBP作为CRT-D的替代品至关重要.
研究的目的:
- 评估双室LBBP作为CRT-D替代品在患有CLBBB的心力衰竭患者的疗效.
- 评估LBBP对左心室喷射率 (LVEF) 和心室内同步的影响.
- 确定可能从LBBP中受益的患者子组,并避免植入可植入心脏转换器-除器 (ICD) 植入.
主要方法:
- 追溯队列研究,包括34名心力衰竭患者,具有CLBBB和CRT-D指示.
- 包括标准:LVEF<35%,NYHAII-IV类,CLBBB (斯特劳斯标准),腹腔内异步.
- 排除标准:缺血性心肌病,在CMR上显著的LGE,二次预防ICD指示.
主要成果:
- LBBP显著改善了LVEF,从31.1%提高到61.0% (P < 0.001).
- 所有患者都实现了超级反应,LVEF>50%.
- 腹腔室内异步标志物,SPWMD和SDI,在LBBP后显著下降 (P < 0.001).
结论:
- 双室LBBP是一种有效的替代疗法,可用于选择患有CLBBB的心力衰竭的患者.
- LBBP可以显著改善心脏功能和心脏同步.
- 符合特定标准的患者可以通过选择LBBP来避免ICD植入.
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