Mischke Karl, Knackstedt Christian, Fache Kerstin, Reith Sebastian, Rana Obaida, Saygili Erol, Gemein Christopher, Becker Michael, Marx Nikolaus, Schauerte Patrick
Départment of Cardiology, Pneumatology and Angiology, RWTH Aachen University, Germany;
Acta Cardiol. 2011 Apr;66(2):175-80. doi: 10.1080/ac.66.2.2071248.
Cardiac resynchronization therapy (CRT) provides a therapeutic option for patients with congestive heart failure (CHF) and left bundle-branch block. Structural myocardial remodelling due to CRT has been described extensively. We hypothesized that CRT might also induce electrical remodelling, thus decreasing the intrinsic QRS duration.
In 38 patients with CHF (ejection fraction (EF): 26 +/- 7%) a CRT device was implanted. 18 patients suffered from ischaemic cardiomyopathy (ICM) and 20 from dilated cardiomyopathy (DCM). Echocardiography and 12-lead ECGs without pacing were obtained prior to implantation and after 6 and 12 months. Patients were classified as responders in case of an increase in EF > or = 25% in combination with an increase in NYHA class > or = 1. Variance analysis was performed to determine the impact of response or underlying heart disease (ICM/DCM) on the extent of change in QRS duration (delta QRS duration).
The EF increased to 36 +/- 10% (P < 0.0001) after 6 months and 40 +/- 12% (P < 0.0001) after 12 months of CRT. Intrinsic QRS duration decreased from 171 +/- 18 ms before CRT to 164 +/- 23 ms (P = 0.027) after 6 months and 161 +/- 25 ms (P = 0.002) after 12 months of CRT. 22 patients (58%) were classified as responders. Whereas a significant decrease in intrinsic QRS duration was observed in responders, only a slight decrease was seen in non-responders. However, two-factorial variance analyses did not show a significant influence of response or underlying heart disease (ICM/DCM) on delta QRS duration (P = 0.7).
CRT results in an electrical remodelling with a reduction of the intrinsic QRS duration.
心脏再同步治疗（CRT）为充血性心力衰竭（CHF）合并左束支传导阻滞的患者提供了一种治疗选择。CRT导致的心肌结构重塑已被广泛描述。我们推测CRT可能还会诱发电重塑，从而缩短固有QRS时限。
38例CHF患者（射血分数（EF）：26±7%）植入了CRT装置。18例患者患有缺血性心肌病（ICM），20例患有扩张型心肌病（DCM）。在植入前以及植入后6个月和12个月时进行了超声心动图检查和无起搏的12导联心电图检查。若EF增加≥25%且纽约心脏协会（NYHA）心功能分级增加≥1级，则患者被归类为反应者。进行方差分析以确定反应或潜在心脏病（ICM/DCM）对QRS时限变化幅度（ΔQRS时限）的影响。
CRT治疗6个月后EF增加到36±10%（P<0.0001），12个月后增加到40±12%（P<0.0001）。固有QRS时限从CRT治疗前的171±18毫秒降至6个月后的164±23毫秒（P=0.027）和12个月后的161±25毫秒（P=0.002）。22例患者（58%）被归类为反应者。反应者的固有QRS时限显著缩短，而非反应者仅略有缩短。然而，双因素方差分析未显示反应或潜在心脏病（ICM/DCM）对ΔQRS时限有显著影响（P=0.7）。
CRT导致电重塑，固有QRS时限缩短。
