在没有心房节奏需要的患者中,使用双室发生器的经济高效的CRT
Pedro J Diaz Delgado1, Aashish Katapadi2, Douglas Darden1
1Kansas City Heart Rhythm Institute, 5100 W 110th Street, Suite 200, Overland Park, KS, 66211, USA.
概括
通过左捆分支区域节奏来重新利用双腔器件进行心脏再同步治疗 (CRT) 是安全且具有成本效益的. 这种方法可以扩大CRT的访问减少喷射分数的患者,特别是在资源有限的地区.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 电子生理学 电子生理学
背景情况:
- 心脏再同步疗法 (CRT) 改善了左心室喷射分数 (LVEF) 减少的患者的结果.
- 高昂的设备成本可能会限制CRT的可访问性.
- 需要使用替代步调策略来扩大CRT接入.
研究的目的:
- 评估使用双室心脏起器或可植入心脏转换器-除器 (ICD) 的心脏前庭端口用于左束支部区域节奏 (LBBAP) 以提供CRT的可行性,安全性和成本效益.
- 评估这项LBBAP策略对LVEF和QRS持续时间的影响.
主要方法:
- 用双室发电机对18名接受LBBAP治疗的患者进行了回顾性分析.
- 为左捆分支节奏带重新使用心脏口.
- 在12个月内评估LVEF,QRS持续时间和并发症.
- 成本分析,将重新设计的策略与标准CRT设备进行比较.
主要成果:
- 通过重新设计的双室发电机进行LBBAP是可行的和安全的,没有程序内并发症.
- 在心脏起器患者中,左心室喷射分数 (LVEF) 保持稳定;有限的ICD数据表明LVEF有所改善.
- 观察到适度的QRS缩小.
- 与标准CRT-D和CRT-P设备相比,证明了显著的成本节约.
结论:
- 通过LBBAP通过双室发电机输送CRT对于没有心房节奏需求的患者来说是一个可行的,安全的和具有成本效益的替代方案.
- 这一战略有可能提高CRT的可访问性,特别是在资源有限的环境中.
- 需要进行更大规模的研究来验证这些发现.
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