对于伴有左束支传导阻滞的扩张型衰竭心脏，收缩功能改善和机械性再同步化并不需要电同步。
Systolic improvement and mechanical resynchronization does not require electrical synchrony in the dilated failing heart with left bundle-branch block.
作者信息
Leclercq Christophe, Faris Owen, Tunin Richard, Johnson Jennifer, Kato Ritsuchi, Evans Frank, Spinelli Julio, Halperin Henry, McVeigh Elliot, Kass David A
机构信息
Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Md, USA.
出版信息
Circulation. 2002 Oct 1;106(14):1760-3. doi: 10.1161/01.cir.0000035037.11968.5c.
BACKGROUND
Biventricular (BiV) and left ventricular (LV) pacing similarly augment systolic function in left bundle-branch block (LBBB)-failing hearts despite different electrical activation. We tested whether electrical synchrony is required to achieve mechanical synchronization and functional benefit from pacing.
METHODS AND RESULTS
Epicardial mapping, tagged MRI, and hemodynamics were obtained in dogs with LBBB-failing hearts during right atrial, LV, and BiV stimulation. BiV and LV both significantly improved chamber hemodynamics (eg, 25% increase in dP/dt(max) and aortic pulse pressure) compared with atrial pacing-LBBB, and this improvement correlated with mechanical resynchronization. Electrical dispersion, however, decreased 13% with BiV but increased 23% with LV pacing (P<0.01).
CONCLUSION
Improved mechanical synchrony and function do not require electrical synchrony. Mechanical coordination plays the dominant role in global systolic improvement with either pacing approach.
背景
尽管电激活方式不同，但双心室（BiV）起搏和左心室（LV）起搏在左束支传导阻滞（LBBB）伴心力衰竭的心脏中同样能增强收缩功能。我们测试了实现机械同步和起搏功能益处是否需要电同步。
方法和结果
在右心房、左心室和双心室刺激过程中，对患有LBBB伴心力衰竭的犬进行心外膜标测、标记MRI和血流动力学检测。与心房起搏-LBBB相比，双心室和左心室起搏均显著改善了心腔血流动力学（例如，dP/dt（max）和主动脉脉压增加25%），且这种改善与机械再同步相关。然而，双心室起搏时电离散度降低了13%，而左心室起搏时电离散度增加了23%（P<0.01）。
结论
改善机械同步和功能并不需要电同步。在任何一种起搏方式中，机械协调性在整体收缩功能改善中起主导作用。
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