Deneke T, Lemke B, Horlitz M, Drüke A, Mügge A, Grewe P H, Lawo T
Herzzentrum der Ruhr-Universität Bochum, BG Universitätsklinik Bergmannsheil Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
Herzschrittmacherther Elektrophysiol. 2008 Mar;19(1):11-8. doi: 10.1007/s00399-008-0597-x.
Cardiac resynchronization (CRT) has evolved as a therapeutic add-on tool in patients with refractory heart failure. Additional pacing of the left ventricle leads to relevant clinical and hemodynamic improvement. Optimized programming of these pacing systems may modulate therapeutic efficacy. Optimal atrio-ventricular (AV) and ventriculo-ventricular (VV) delay programming is documented to increase invasively and non-invasively determined parameters of cardiac hemodynamics. In this manuscript different options for determining optimal AV and VV delay are discussed and a pragmatic approach to optimize CRT programming is detailed. VV delay needs to be optimized as a first step of programming. Different techniques may estimate the individual need for sequential ventricular pacing. Especially electrocardiographic criteria during right and left ventricular pacing may approximate the time-delay for pre-excitation. Delay between aortic and pulmonic valve ejection can be determined using Doppler echocardiography may identify patients who benefit from sequential pacing. Optimizing AV delay is a domain of Doppler echocardiography where using a simple formula the AV delay that produces the best diastolic resynchronization of left atrial contraction and left ventricular ejection can be calculated.Using the above mentioned techniques a pragmatic, easy and fast method for increasing CRT performance can be established. In cases of worsening heart failure or relevant changes of left ventricular dimensions adaptions (re-optimization) of VV and AV delay may be needed.
心脏再同步治疗（CRT）已发展成为难治性心力衰竭患者的一种附加治疗工具。左心室的额外起搏可带来相关的临床和血流动力学改善。这些起搏系统的优化程控可能会调节治疗效果。有文献记载，优化房室（AV）和室间（VV）延迟程控可增加通过有创和无创方法测定的心脏血流动力学参数。本文讨论了确定最佳AV和VV延迟的不同方法，并详细阐述了一种优化CRT程控的实用方法。VV延迟需要作为程控的第一步进行优化。不同的技术可估计心室顺序起搏的个体需求。特别是右心室和左心室起搏期间的心电图标准可近似预激的时间延迟。使用多普勒超声心动图测定主动脉和肺动脉瓣射血之间的延迟可识别从顺序起搏中获益的患者。优化AV延迟是多普勒超声心动图的一个领域，通过一个简单公式可计算出产生左心房收缩和左心室射血最佳舒张期再同步的AV延迟。利用上述技术，可建立一种实用、简便且快速的提高CRT性能的方法。在心力衰竭恶化或左心室尺寸发生相关变化的情况下，可能需要对VV和AV延迟进行调整（重新优化）。
