Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba Graduate School of Comprehensive Human Sciences, Ibaraki, Japan.
Am J Cardiol. 2011 Nov 1;108(9):1297-304. doi: 10.1016/j.amjcard.2011.06.048. Epub 2011 Aug 17.
The advantages of triple-site ventricular pacing (Tri-V) compared to conventional biventricular site pacing (Bi-V) have been reported. We sought to identify the predictors of acute hemodynamic Tri-V responders. Acute hemodynamic studies were performed in 32 patients with advanced heart failure during Tri-V implantation. After the right ventricular (RV) and left ventricular (LV) leads were implanted for a conventional Bi-V system, an additional pacing lead was implanted in the RV outflow tract for Tri-V. The LV peak +dP/dt and tau were measured during AAI, Bi-V, and Tri-V pacing. A Tri-V responder was defined as a patient whose percentage of increase in the peak +dP/dt during Tri-V was >10% compared to of that during Bi-V. The baseline clinical variables and RV outflow tract lead location were analyzed to identify the characteristics of the Tri-V responders. Of the 32 patients, 10 (31%) were classified as Tri-V responders. The LV end-diastolic volume was greater (246 ± 48 vs 173 ± 53 ml, p <0.01), and the RV outflow tract lead was implanted at a greater outflow tract portion (p <0.05) in the Tri-V responders. Multivariate analysis revealed that only the baseline LV end-diastolic volume (per 50-ml greater) predicted the Tri-V response (odds ratio 2.87, 95% confidence interval 1.03 to 8.00, p <0.05). The area under the receiver operating characteristic curve for the LV end-diastolic volume was 0.84 (p <0.01) and an LV end-diastolic volume of >212 ml had a sensitivity of 80% and specificity of 77% to distinguish Tri-V responders. In conclusion, Tri-V provides greater hemodynamic effect for patients with a larger LV end-diastolic volume owing to its resynchronization effects on the LV anterior wall.
与传统双心室部位起搏（Bi-V）相比，三部位心室起搏（Tri-V）具有优势。我们旨在确定急性血流动力学Tri-V 反应者的预测因素。在 Tri-V 植入期间，对 32 例晚期心力衰竭患者进行了急性血流动力学研究。在植入常规 Bi-V 系统的右心室（RV）和左心室（LV）导线后，在 RV 流出道植入了一个额外的起搏导线以实现 Tri-V。在 AAI、Bi-V 和 Tri-V 起搏期间测量 LV 峰 +dP/dt 和 tau。将 Tri-V 反应者定义为与 Bi-V 相比，Tri-V 期间峰 +dP/dt 增加百分比> 10%的患者。分析基线临床变量和 RV 流出道导联位置，以确定 Tri-V 反应者的特征。在 32 例患者中，有 10 例（31%）被归类为 Tri-V 反应者。Tri-V 反应者的 LV 舒张末期容积更大（246 ± 48 比 173 ± 53 ml，p <0.01），RV 流出道导联植入于 RV 流出道更大的部分（p <0.05）。多变量分析显示，只有基线 LV 舒张末期容积（每增加 50-ml）可预测 Tri-V 反应（优势比 2.87，95%置信区间 1.03 至 8.00，p <0.05）。LV 舒张末期容积的接收器操作特性曲线下面积为 0.84（p <0.01），LV 舒张末期容积> 212 ml 时，区分 Tri-V 反应者的敏感性为 80%，特异性为 77%。总之，由于 Tri-V 对 LV 前壁具有再同步化作用，因此对于 LV 舒张末期容积较大的患者，Tri-V 可提供更大的血流动力学效果。
