D'Ivernois Christophe, Lesage Jérôme, Blanc Patrick
Service de Cardiologie, Hôpital Universitaire Dupuytren, Limoges, France.
Pacing Clin Electrophysiol. 2008 Aug;31(8):1041-5. doi: 10.1111/j.1540-8159.2008.01132.x.
The recommended left ventricular (LV) lead position for cardiac resynchronization therapy (CRT) is at the lateral or posterolateral wall. However, LV leads cannot always be implanted at this site. The objective of our study was to compare the clinical response to CRT when the LV lead could be implanted or not at the lateral or posterolateral wall.
In consecutive patients implanted with a CRT device, we documented the final position achieved by the tip of the LV lead in the left anterior oblique projection. Patients were prospectively followed for 6 months after implantation. They were defined as responders if they were alive, had gained 1 New York Heart Association (NYHA) functional class, and had not been hospitalized for heart failure.
The study population consisted of 77 patients (56 men, 71 +/- 10 years, 62 NYHA class III, 15 NYHA class IV). The LV lead was implanted at the lateral or posterolateral wall in 54 patients (group A) and at the anterior or anterolateral wall in 23 patients (group B). At 6 months, seven patients (9%) died (all in group A). There were 37 responders (69%) in group A as compared to 22 (96%) in group B.
The responder rate was not inferior when the LV lead was implanted at the anterior or anterolateral wall. Thus, in case of failed implantation at the lateral or posterolateral wall, positioning the LV lead in a more anterior location appears to be a reasonable alternative. Further studies are required to confirm these findings.
心脏再同步治疗（CRT）推荐的左心室（LV）导联位置是侧壁或后侧壁。然而，LV导联并非总能植入该部位。我们研究的目的是比较LV导联能否植入侧壁或后侧壁时CRT的临床反应。
在连续植入CRT装置的患者中，我们记录了左前斜位投影下LV导联尖端最终到达的位置。患者在植入后进行了6个月的前瞻性随访。如果患者存活、纽约心脏协会（NYHA）心功能分级提高1级且未因心力衰竭住院，则被定义为反应者。
研究人群包括77例患者（56例男性，71±10岁，62例NYHAⅢ级，15例NYHAⅣ级）。54例患者（A组）的LV导联植入侧壁或后侧壁，23例患者（B组）的LV导联植入前壁或前侧壁。6个月时，7例患者（9%）死亡（均在A组）。A组有37例反应者（69%），B组有22例（96%）。
LV导联植入前壁或前侧壁时反应率并不低。因此，在侧壁或后侧壁植入失败的情况下，将LV导联置于更靠前的位置似乎是一个合理的选择。需要进一步研究来证实这些发现。
