Dohi Kaoru, Suffoletto Matthew, Ganz Leonard, Zenati Marco, Gorcsan John
University of Pittsburgh, Pittsburgh, Pennsylvania 15213-2582, USA.
Pacing Clin Electrophysiol. 2005 May;28(5):461-5. doi: 10.1111/j.1540-8159.2005.40056.x.
An 80-year-old woman with severe symptomatic heart failure (ejection fraction of 13%), and left bundle branch block (QRS duration of 160 ms) underwent cardiac resynchronization therapy (CRT). She had significant baseline dyssynchrony with a septal to posterior wall delay of 160 ms by echocardiographic tissue synchronization imaging (TSI). Despite exhaustive efforts, a stable posterior-lateral coronary vein lead position could not be achieved with the standard percutaneous approach, resulting in anterior coronary vein lead placement. This resulted in no improvement in the patient's symptoms or ventricular function. Follow-up TSI revealed earlier activation of the anteroseptal site and worsened dyssynchrony with septal to posterior wall delay of now 290 ms. This information prompted surgical revision of the left ventricular (LV) lead position via limited thoracotomy and posterior-lateral epicardial lead implantation. Pacing at the new lead site resulted in a 30% increase in stroke volume and symptomatic improvement. TSI in this case redirected lead position in a clinical nonresponder, resulting in a favorable response to CRT.
一名80岁女性，患有严重症状性心力衰竭（射血分数为13%）且存在左束支传导阻滞（QRS波时限为160毫秒），接受了心脏再同步治疗（CRT）。通过超声心动图组织同步成像（TSI）检查，她存在明显的基线不同步，室间隔至后壁延迟为160毫秒。尽管竭尽全力，但采用标准经皮方法未能获得稳定的后侧冠状静脉导联位置，最终将导联置于前侧冠状静脉。这导致患者症状和心室功能均未改善。随访TSI显示前间隔部位激活提前，不同步加重，室间隔至后壁延迟增至290毫秒。这一信息促使通过有限开胸手术对左心室（LV）导联位置进行手术修正，并植入后侧心外膜导联。在新的导联部位进行起搏使每搏输出量增加了30%，症状也有所改善。在本例中，TSI为临床无反应者重新确定了导联位置，从而使患者对CRT产生了良好反应。
