Van Gelder Berry M, Bracke Frank A, Van Der Voort Pepijn H, Meijer Albert
Catharina Hospital, Eindhoven, The Netherlands.
Pacing Clin Electrophysiol. 2007 Apr;30(4):476-81. doi: 10.1111/j.1540-8159.2007.00696.x.
In cardiac resynchronization therapy (CRT), the atrio-ventricular (AV) and interventricular (VV) intervals have to be optimized. For maximal optimization, the paced and sensed AV intervals have to be determined. We hypothesized that the morphology of the paced QRS complex at the optimal paced AV interval (PAV) can be used to determine the optimal sensed AV (SAV) interval in patients with normal AV conduction.
In 16 patients with implanted CRT devices, the optimal PAV and V-V interval were determined by invasive measurement of left ventricle (LV) dP/dt(max). A 12-lead electrocardiogram (ECG) was recorded at the optimum setting. Subsequently, during atrial sensing ventricular pacing, the SAV interval was changed until the QRS morphology was identical to the morphology at the optimal PAV interval. The optimal SAV interval was verified by repeated measurement of LV dP/dt(max).
By optimization of the PAV and VV interval, the LV dP/dt(max) increased from 639 +/- 204 to 789 +/- 223 mmHg/s (+23%; P = 0.0000002). The optimized PAV was 149 +/- 19 ms; the optimized SAV was 100 +/- 20 ms and the corresponding LV dP/dt(max) at this interval was 774 +/- 204 ms (+21%; P = 0.000004). LV dP/dt(max) at optimized SAV - 20 ms and optimized SAV + 20 ms was 747 +/- 213 mmHg/s (P = 0.00004) and 751 +/- 203 mmHg/s (P = 0.0000003), respectively. The mean difference in optimized PAV and optimized SAV was 49 +/- 17 ms, ranging from 20 to 80 ms.
The QRS morphology at optimized PAV can be used as a template to determine the optimal SAV, provided that the patient has normal AV conduction.
在心脏再同步治疗（CRT）中，房室（AV）间期和心室间（VV）间期必须进行优化。为实现最大程度的优化，必须确定起搏和感知的AV间期。我们假设，在具有正常房室传导的患者中，最佳起搏AV间期（PAV）时的起搏QRS波群形态可用于确定最佳感知AV（SAV）间期。
对16例植入CRT设备的患者，通过有创测量左心室（LV）dP/dt（max）来确定最佳PAV和V-V间期。在最佳设置下记录12导联心电图（ECG）。随后，在心房感知心室起搏期间，改变SAV间期，直至QRS形态与最佳PAV间期时的形态相同。通过重复测量LV dP/dt（max）来验证最佳SAV间期。
通过优化PAV和VV间期，LV dP/dt（max）从639±204 mmHg/s增加至789±223 mmHg/s（增加23%；P = 0.0000002）。优化后的PAV为149±19 ms；优化后的SAV为100±20 ms，此间期对应的LV dP/dt（max）为774±204 ms（增加21%；P = 0.000004）。优化SAV - 20 ms和优化SAV + 20 ms时的LV dP/dt（max）分别为747±213 mmHg/s（P = 0.00004）和751±203 mmHg/s（P = 0.0000003）。优化后的PAV与优化后的SAV的平均差值为49±I7 ms，范围为20至80 ms。
倘若患者具有正常房室传导，优化PAV时的QRS形态可作为模板来确定最佳SAV。
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