对接受无效心脏再同步治疗的患者进行节奏的优化
Nobuhiko Ueda1, Satoshi Oka1, Kohei Ishibashi1
1Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Heart rhythm
|October 19, 2025
概括
高效率的心脏再同步治疗 (CRT) 节奏,通常是由于伪融合或延迟,与糟糕的结果有关. 优化节奏延迟可以显著减少无效的CRT,并改善患者的反应.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 医疗器械技术 医疗器械技术
背景情况:
- 有效的节奏对于心脏再同步治疗 (CRT) 的成功至关重要.
- 高率的无效CRT (i-CRT) 与不良的患者预后有关.
- 高%i-CRT的特征和最佳管理仍然不太清楚.
研究的目的:
- 调查与高无效CRT (%i-CRT) 相关的特定患者特征.
- 评估节奏优化策略在患有高%i-CRT的患者中的有效性.
- 确定高%i-CRT的常见原因及其对CRT响应的影响.
主要方法:
- 评估了225名使用EffectivCRT系统测量%i-CRT的患者.
- 定义CRT反应为改善的LVEF (≥10%) 和/或减少的LVESV (≥15%).
- 确定高%i-CRT为>2.0%并分析了伪融合或延迟等原因.
主要成果:
- 16%的患者 (36/225) 呈现高%i-CRT,显示显著较低的CRT应答率 (48%对76%).
- 伪融合或延迟是高%i-CRT的主要原因,较早发生,水平更高.
- 10名患者的节奏优化将%i-CRT从64.6%降低到6.4%,QRS持续时间从165毫秒降低到138毫秒,将3名非响应者转换为响应者.
结论:
- 高i-CRT,特别是具有延迟或伪融合,在CRT治疗的早期出现.
- 优化心房心室或心室间延迟可以有效地减少i-CRT.
- 节奏优化提高了CRT的有效性,缩短了QRS的持续时间,可能转换非响应者.
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