Singh Jagmeet P, Heist E Kevin, Ruskin Jeremy N, Harthorne J Warren
Cardiac Resynchronization Therapy Program, Heart Center & Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
J Interv Card Electrophysiol. 2006 Oct;17(1):51-8. doi: 10.1007/s10840-006-9050-4. Epub 2007 Jan 25.
Several reports have indicated that left ventricular (LV) lead placement at an optimal anatomic pacing site is a critical determinant of outcome of cardiac resynchronization therapy (CRT). Selecting the 'right' patient for CRT but stimulating the 'wrong' site remains an important cause for the high incidence of non-responders to CRT. This technical report (a) recognizes the variance in the coronary venous anatomy and its impact on the final LV lead position, (b) emphasizes the importance of the ventricular electrical activation pattern and its alteration with RV and LV pacing and (c) proposes a novel method to "dial-in" the site for right ventricular (RV) pacing to maximize the electrical separation from the left ventricular lead, rather than taking the first acceptable RV site in the apex or the apico-septal region. This electrical distancing of the leads will potentially improve the mechanics of ventricular contraction and the flexibility of RV-LV optimization.
多项报告表明，将左心室（LV）导线置于最佳解剖起搏部位是心脏再同步治疗（CRT）疗效的关键决定因素。为CRT选择了“合适”的患者，但刺激了“错误”的部位，仍然是CRT无反应者高发生率的一个重要原因。本技术报告（a）认识到冠状静脉解剖结构的差异及其对最终LV导线位置的影响，（b）强调心室电激活模式的重要性及其随右心室（RV）和左心室起搏的改变，（c）提出一种新颖的方法来“微调”右心室（RV）起搏部位，以最大限度地增加与左心室导线的电距离，而不是在 apex或心尖-间隔区域选择第一个可接受的RV部位。导线的这种电距离可能会改善心室收缩机制以及RV-LV优化的灵活性。
